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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, behavioral health, 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.

Credentialing made easier

Credentialing involves two key steps:

  1. Apply for credentialing using the Practitioner Participation Form.
  2. Any professional provider interested in participating in our network must also complete and return a credentialing application kit. The CAQH ProView® (CAQH) electronic credentialing application is free to providers and available on the CAQH ProView website.

A summary of the credentialing process

  1. In addition to your application, you must submit all required supporting documentation. Please ensure you have allowed access to your CAQH application and that it is updated with the correct information and matches what is listed on your Practitioner Participation Form for credentialing.
  2. Once we have received all required documents, we will review the information on your CAQH application to ensure that it is consistent with the information provided on your Practitioner Participation Form. Please be sure to grant AmeriHealth Credentialing permission to view/pull-in your CAQH application.
  3. Once your credentialing application has been approved, you will receive an email from DocuSign with our standard provider contract, if required.
  4. You have 30 calendar days from the date of the DocuSign email to electronically sign and return the contract. Please note: If the contract is NOT returned within this time frame, your credentialing application will be rescinded, and you will need to reapply if you still wish to become part of the AmeriHealth network.

CRNPs

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. Review scenarios where CRNPs are only allowed to be contracted and credentialed with AmeriHealth.

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.

Contact information

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:

*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.