Developer resources

AmeriHealth machine readable files

AmeriHealth is required to make available to the public, machine readable files effective for plan years on and after January 1, 2022. These files will be updated monthly and are meant for use by third-party developers, consultants, government agencies, and employers.

• Enforcement date for in and out-of-network machine readable files is July 1, 2022
• Enforcement date for the pharmacy machine-readable file is delayed pending further rule-making

Machine readable files

• AmeriHealth NJ Insurance Co, Inc.
• AmeriHealth HMO, Inc.
• AmeriHealth PA HMO, Inc.

These files are not designed for use by members. Members are encouraged to use the care cost estimator tool available on the AmeriHealth member website or mobile app. These files are not a guarantee of coverage, nor a guarantee of the reimbursement rate that will be applied for any procedure. The claims reimbursement process is subject to a variety of factors that are not addressed in these files, including eligibility, medical necessity determinations, utilization management requirements, exclusions and other plan terms. These files also do not offer any information on a member’s out-of-pocket charges.

Carrier data sets

AmeriHealth HMO, Inc.

• Provider Data
• Medical Data
• Vision Data
• Pharmacy Data
• Formulary Data
• Plan Data
  • Index File

AmeriHealth Insurance Company of New Jersey

• Provider Data
• Medical Data
• Vision Data
• Pharmacy Data
• Formulary Data
• Plan Data
  • Index File

Commercial directories:

This directory is updated monthly throughout the year. It is important to know that when you enroll in this plan, covered services are provided through the AmeriHealth health care provider network. AmeriHealth reserves the right to add or delete participating physicians, hospitals, and/or other health care providers at any time. AmeriHealth cannot guarantee the continued participation of any one doctor, hospital, or other health care provider. It is very important that you verify your provider’s network membership before receiving services. For updated or more detailed information regarding participating providers, visit our website at www.amerihealth.com, or call Customer Service at 1-888-968-7241 Monday through Friday, 8 a.m. to 6 p.m. TTY/TDD users should call 711.