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Professional provider credentialing

Credentialing made easier for Pennsylvania providers

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 Please note: If the contract is NOT returned within this time frame, your credentialing application will be rescinded, and you will need to reapply if you still wish to become part of the AmeriHealth network.

Network area: Pennsylvania and Delaware

If you have a primary practice address in Pennsylvania or Delaware and would like to join our network(s), you must notify AmeriHealth by submitting a Practitioner Participation Form.

CRNPs

Certified registered nurse practitioners (CRNP) 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. To see scenarios where CRNPs are only allowed to be contracted and credentialed with AmeriHealth, please read about Professional provider credentialing.

Accreditation requirement 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, email us at qualitymanagement@amerihealth.com. Be sure to include your name, contact number, and provider ID number in your email.

Closed networks

The following professional provider networks have participation limitations:

Chiropractic

The chiropractic network is closed to new providers in Pennsylvania and Delaware except when the provider meets one of the following conditions:

  • When the provider is joining an existing participating group
  • When a non-participating provider is purchasing the assets of a participating provider, and the participating provider is terminating their AmeriHealth agreement

Pathology

The pathology provider network is closed for new office-based pathology providers in the AmeriHealth service area (i.e., participating counties in Pennsylvania, Delaware, and Maryland) except when the pathologist meets the following condition:

  • A pathology provider is joining an existing participating hospital-based pathology group in a participating hospital in our service area (as identified above).

Note: Pathologists cannot be added to participating non-pathology practices.

Podiatry

The podiatry network is closed to new providers except when the provider meets one or more of the following conditions:

  • When the provider is located outside of Bucks, Chester, Delaware, Montgomery, and Philadelphia counties
  • When the provider is joining an existing participating group
  • When a non-participating provider is purchasing the assets of a participating provider, and the participating provider is terminating their AmeriHealth agreement.