If information in the AmeriHealth provider directory is incorrect, it has a negative impact on our members. Therefore, it is critical that you regularly review your demographic information in the provider directory to ensure that all of the information is accurate.

In compliance with new guidance issued by the Centers for Medicare & Medicaid Services (CMS), AmeriHealth is working to ensure the accuracy of our provider directory. To support the success of this important initiative, we need your participation.

Review your provider information regularly

Provider offices should review their demographic information published in the provider directory on a quarterly basis. You can view your current listing online using the Find a Doctor tool (i.e., online provider directory) for AmeriHealth New Jersey and AmeriHealth Pennsylvania.

Please be sure to address the following questions when reviewing your provider demographic information:

• Can members make an appointment with the practitioner at the location for which he or she is listed?
• With which plans is the practitioner currently participating?
• Is the practitioner accepting or not accepting new patients at the location listed?
• Is the practitioner specialty (e.g., primary care physician, cardiologist, oncologist) accurate for the location listed?
• Can members use the phone number listed for the location to call and make an appointment?
• Are the names for the practitioner and practice correct?

In addition to accuracy checks being conducted by CMS based on the information found in our provider directory, you may also be contacted by AmeriHealth to verify the accuracy of this information. AmeriHealth may request verification of this information via fax or phone audit.

Educating office staff

It is essential that staff members in your provider office are educated about the practice or facility. Please note the following important details:

• Health plan participation. Educate office staff about which AmeriHealth health plans are accepted at your practice, as it is imperative that all staff can answer this question for members calling for an appointment. For example, be sure that the office staff is aware of the provider?s participation status and tier for plans such as AmeriHealth Advantage or Tier 1 Advantage, which have a tiered provider network.
• Location affiliations. Ensure that the front and back office staff members are educated about all providers seeing patients at your practice location. Providers must only be affiliated with locations where they are seeing patients and scheduling appointments. Claims adjudication will occur regardless of office location, as long as the provider is affiliated with your group.
• Consistency across all office staff. Ensure that the front and back office staff members are educated about important provider office details, such as whether new patients are being accepted and the health plans in which the provider participates.

How to update your information*

As changes become apparent in your practice or facility, you are required to communicate those changes to AmeriHealth. As outlined in the Administrative Procedures section of the Provider Manual for Participating Professional Providers (Provider Manual) and the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital Manual), AmeriHealth requires 30 days advanced notice to process most updates, including:

• updates to address, office hours, total hours, phone number, or fax number;
• changes in selection of capitated providers (HMO primary care physicians 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).

For more details about requirements for keeping your provider information up to date, please refer to the Administrative Procedures section of the Provider Manual or Hospital Manual, as applicable.

Failure to comply with regulations or provide proper notice

Per your AmeriHealth Professional Provider Agreement and/or Hospital, Ancillary Facility, or Ancillary Provider Agreement, providers are required to comply with all applicable local, state, and federal laws, rules, and regulations to the extent that they directly or indirectly affect the provider and/or AmeriHealth.

AmeriHealth will not be responsible for changes not processed due to lack of proper notice. Failure to provide proper advanced written notice to AmeriHealth regarding provider changes may delay or otherwise affect provider payment and your designation in our provider directory. Lack of designation in the provider directory would inhibit members from selecting your practice or facility for care.

Thank you in advance for your participation in this important effort to ensure that our members have access to the most current information about our provider network. If you have further questions, please contact your Provider Partnership Associate or your Network Coordinator.

*Behavioral health providers contracted with Magellan Healthcare, Inc. 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.

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