Becoming a credentialed professional provider

November 16, 2020

AmeriHealth requires credentialing of all physicians and all other types of health care providers who provide services to AmeriHealth members and who are permitted to practice independently under applicable state law. All providers must be credentialed and contracted before they are allowed to provide care to AmeriHealth members.*

Information on our network credentialing process and credentialing criteria can be found on the credentialing webpages for AmeriHealth New Jersey and AmeriHealth Pennsylvania or in the Quality Management section of the Provider Manual for Participating Professional Providers.

Submitting credentialing applications

To ensure that credentialing applications are managed in a timely manner, it is important for providers to adhere to the processes outlined below for provider credentialing.

All professional providers interested in becoming a participating provider must apply for credentialing by completing the online Practitioner Participation Form for AmeriHealth New Jersey or AmeriHealth Pennsylvania.

Providers interested in becoming credentialed in New Jersey are strongly encouraged to first complete the Council for Affordable Quality Healthcare’s (CAQH) online credentialing application: CAQH ProView®. However, AmeriHealth New Jersey will accept the New Jersey Universal Physician Credentialing application. To become credentialed in Pennsylvania, providers are required to also complete CAQH ProView.

If your practice contracts with multiple health plans, the CAQH ProView online application minimizes the administrative work needed to fill out multiple, redundant, and time-consuming forms.

If you have already been credentialed by AmeriHealth, there is no need to resubmit a Practitioner Participation Form or a CAQH ProView credentialing application.

Important credentialing notes:

  • Any professional provider interested in participating in our network must complete the Practitioner Participation Form and the CAQH ProView credentialing application.
  • 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.

Submitting requests not related to credentialing

The Practitioner Participation Form is used strictly for credentialing applications. If you need to make changes to your basic provider information (e.g., updating names, addresses, office hours, contact information associated with your practice, or joining a new practice), please use our Demographic Maintenance Guide for AmeriHealth New Jersey or AmeriHealth Pennsylvania

Learn more

If you have additional questions on the credentialing process or would like to check the status of your application, please email our Credentialing Operations Department at CredInquiries@amerihealth.com.

*Behavioral health providers must be credentialed by and contracted with Magellan Healthcare, Inc. Interested behavioral health providers can contact Magellan by selecting the “Join the Network” link or by contacting their Magellan Provider Services Line at 1-800-788-4005 for assistance.

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