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Network participation and credentialing

Professional providers

Professional providers include but are not limited to the following specialties: physicians, radiologists, Certified Register Nurse Practitioners (CRNP), physical therapists, registered dieticians, etc.

Most licensed practitioners are board-certified physicians. If a physician is not board certified, the required number of educational years deemed sufficient per the Accreditation Council for Graduate Medical Education (ACGME) guidelines would need to be primarily source verified. There are some instances where a practitioner is not board certified, and the educational institution per their policy requires a payment for the verification of a completed program. As needed for cases where education requires a charge, AmeriHealth will place the responsibility on the practitioner for the required verification from the institution to be sent directly to the Credentialing Operations processor.

Important credentialing notes

It typically takes 90-120 days to complete the credentialing process once AmeriHealth has received all requested documentation. We remind you to please respond promptly to all inquiries for documentation.

  • Any professional provider interested in participating in our network must complete the Practitioner Participation Form.
  • Any credentialing application request not received through the Practitioner Participation Form will be returned with instructions to submit the request using the form
  • The Practitioner Participation Form is only for credentialing applications.
  • CRNPs must have a collaborative agreement with a participating physician who holds a current and unrestricted license. The training and scope of practice of the collaborating physician must be consistent with the practice of the CRNP. See scenarios where CRNPs are only allowed to be contracted and credentialed with AmeriHealth.

Behavioral health providers

Effective January 1, 2023, AmeriHealth insourced its behavioral health network and is now directly contracting with behavioral health providers. All providers are required to submit their credentialing information to AmeriHealth in order to provide in-network services to our members.

Note: If you have not yet signed an AmeriHealth Professional Provider Agreement, you will be considered out-of-network for our members.

Prior participation in the Magellan Healthcare, Inc. (Magellan) no longer qualifies providers as an in-network provider.

Effective January 1, 2024, however, you will be considered out-of-network for our members.

If you are a behavioral health provider interested in joining our network, the first step is to apply for credentialing by completing the Practitioner Participation Form.

If you do not respond within the designated timeframes, your application will be closed and you will be required to resubmit all information.

Reimbursement terms effective January 1, 2023:

If you currently participate in the Magellan network but have not signed an AmeriHealth Professional Provider Agreement, you will be considered as participating in the AmeriHealth network through December 31, 2023. Effective January 1, 2024, however, you will be considered out-of-network for our members.

  • You will be reimbursed in accordance with the terms and conditions specified in the Magellan Professional Provider Agreement.
  • While you will maintain your in-network participation status to provide services to AmeriHealth members, you will not be eligible for the AmeriHealth terms and conditions (including provider appeal rights and the enhanced AmeriHealth reimbursement) until you sign an AmeriHealth Professional Agreement.
  • Please refer to the steps above to complete the contracting/credentialing process.

To confirm if you are a credentialed provider, search for your name on the AmeriHealth (PA) or AmeriHealth (NJ) Find a Doctor tool.

  • If your name is listed but you need to submit provider demographic changes, please use the online Provider Change Request form: NJ Provider Change Request or PA Provider Change Request.
  • If your name is not listed, it means that your credentialing application is still being processed. For a status update on your application, please contact the Provider Partnership Associate (PPA) who covers the county in which your practice is located (see table below).

Due to the influx of behavioral health providers interested in joining our network, our credentialing process is taking longer than our usual 90-to-120 day process. While we remind you to please respond promptly to all inquiries for documentation, we do apologize for the delay and appreciate your patience.

  • If it has been more than 90 days since you submitted all required credentialing documentation and you wish to check the status of your application, please contact your PPA, found in the table:
PPAs listed only support our Behavioral Health Network.
Providers who are not in the Behavioral Health Network can use the PNS Contact Tool to locate their PPA.
Provider Partnership Associate (PPA) State County
Donna Simmons
Email 		NJ Atlantic, Burlington, Cape May, Gloucester, Middlesex, Monmouth, Salem, Somerset, and Union
Donya Weldon
Email 		NJ & DE Bergen, Camden, Cecil, Cumberland, Essex, Hudson, Hunterdon, Mercer, Morris, New Castle, Ocean, Passaic, Sussex (DE), Sussex (NJ), and Warren
Cyndi Swinton-Jackson
Email 		PA Berks
Amber Davis-Acosta
Email 		PA Lancaster and Lehigh
Judy Wright
Email 		PA Northampton

For general questions, contact Provider Customer Service at:

You can also connect with your Provider Network Services (PNS) contact:

Accreditation requirements for office-based varicose vein procedures

All network offices that perform varicose vein procedures will need to obtain office-level accreditation from the Intersocietal Accreditation Commission (IAC) Vein Center. To learn more about the IAC Vein Center accreditation program, please visit the IAC website or call 1-800-838-2110. If you have additional questions, please email us at qualitymanagement@amerihealth.com. Be sure to include your name, contact number, and provider ID number in your email.

*All information obtained during the credentialing process is confidential and will not be shared with third parties. Submission of the credentialing application and required supporting documentation does not guarantee inclusion in AmeriHealth network(s).

The National Committee for Quality Assurance (NCQA) is the most widely recognized accreditation program in the U.S.