The Provider Manual for Participating Professional Providers (Provider Manual) is part of a provider's Professional Provider Agreement with AmeriHealth HMO, Inc. and its affiliates (collectively referred to as "AmeriHealth").
The manual was developed to assist participating professional providers in conducting business with AmeriHealth in accordance with the Provider Agreement.
The Provider Manual is an easy-to-use reference tool, color-coded, and hyperlinked to provide easy access to the information that providers need most. It is updated regularly to provide pertinent information regarding our policies, procedures, and functions.
Providers may request a print version of the Provider Manual by submitting a request through our online order form.
- Introduction (June 2021)
- General Information (June 2022)
- Administrative Procedures (November 2022)
- Fraud, Waste, & Abuse (October 2021)
- Medical Policy & Claim Payment Policy (June 2021)
- Clinical Services – Utilization Management (October 2021)
- Quality Management (June 2022)
- Behavioral Health (October 2021)
- Billing (October 2021)
- Hospitalization and Outpatient Services (October 2021)
- Specialty Programs (October 2021)
- OB/GYN (October 2021)
- Health and Wellness (October 2021)
- Pharmacy (June 2022)
- Appeals - Delaware (June 2021)
- Appeals - Pennsylvania
- Disclaimer Information (June 2021)