The AmeriHealth companies in New Jersey (AmeriHealth Insurance Company of New Jersey and AmeriHealth HMO, Inc.) and in Pennsylvania (AmeriHealth HMO, Inc.) would like to remind you that submitting changes in a timely manner helps to ensure prompt payment of claims, delivery of critical communications, seamless recredentialing, and accurate listings in our provider directories

In accordance with your Provider Agreement (Agreement), the Provider Manual for Participating Professional Providers (Provider Manual) and/or Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital Manual), as applicable, you are required to notify AmeriHealth whenever key provider demographic information changes.

Professional providers*

As outlined in the Administrative Procedures section of the Provider Manual, AmeriHealth requires advance written notice for updates as outlined below:

• 30-day notice. 
• updates to address, office hours, total hours, phone number, or fax number;
• changes in selection of capitated providers (HMO primary care physicians [PCP] only);
• addition of new providers to your group (either newly credentialed or participating);
• changes to hospital affiliation.
• changes that affect availability to patients (e.g., opening your panel to new patients).
• 60-day notice. AmeriHealth requires 60 days advance written notice for closure of a PCP practice or panel to additional patients.
• 90-day notice. AmeriHealth requires 90 days advance written notice for resignation and/or termination from our network.

Facility and ancillary providers

As outlined in the Administrative Procedures section of the Hospital Manual, AmeriHealth requires 30 days advance written notice to process updates to address, phone number, or fax number, as well as change in ownership.

Reviewing provider data

Participating providers^† can use the Provider Data Maintenance transaction in PEAR Practice Management to view key practice data elements that appear in our provider directory. Per the Consolidated Appropriations Act, participating providers are required to notify us whenever there are changes to their provider data. In addition, health plans are required to verify and update their provider directory information every 90 days. To help us meet this requirement, we ask that you review and attest your provider data every 90 days.  

A Provider Data Maintenance Guide is available to assist you in navigating this transaction. Review the step-by-step guide in the PEAR Help Center under Practice Management – Provider Administration.

If you do not have access to the PEAR portal, review your provider profile on the AmeriHealth New Jersey or AmeriHealth Pennsylvania Find a Doctor tools. Enter your facility/provider name in the search field and review the accuracy of the information presented.

Submitting updates and/or changes^†

If you have a change to your provider data, follow these instructions:​

How to close your practice or terminate your contract

Providers who choose to close their practice or resign from the network should first contact Provider Services at 1-800-275-2583 for AmeriHealth in Pennsylvania or 1-888-YOUR-AH1 for AmeriHealth in New Jersey to discuss the reason for the closure or resignation. In addition to the telephone call, the provider must give the network at least 90 days advance written notice to terminate network participation.

Note: The Provider Change Request cannot be used if you are closing your practice or terminating from the network. 

Authorizing signature and W-9 Forms

Updates resulting in a change on your W-9 Form (e.g., changes to a provider's name, tax ID number, billing vendor or “pay to" address, or ownership) require the following signatures:

• For professional providers:
• Group practices: A signature from a legally authorized representative (e.g., physician or other person who signed the Agreement or one who is legally authorized to bind the group practice) of the practice is required.
• Solo practitioners: A signature from the individual practitioner is required.
• For facility and ancillary providers: Written notification on company letterhead is required.

An updated copy of your W-9 Form reflecting these changes must also be included to ensure that we provide you with a correct 1099 Form for your tax purposes. If you do not submit a copy of your new W-9 Form, your change will not be processed.

AmeriHealth will not be responsible for changes not processed due to lack of proper notice. Failure to provide proper advanced written notice to AmeriHealth may delay or otherwise affect provider payment.

*To ensure appropriate setup in AmeriHealth systems, the same time frames also apply to behavioral health providers contracted with Magellan Healthcare, Inc. (Magellan).

^†Behavioral health providers contracted with Magellan must submit any changes to their practice information to Magellan via their online Provider Data Change form by selecting the “Display/Edit Practice Info" link.

^‡Any change to your primary specialty must be made in accordance with the AmeriHealth credentialing standards. Please note that a specialty change will only be made to the provider directory once AmeriHealth has ensured credentialing criteria have been satisfied.

Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.​