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. AmeriHealth 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.

Professional providers*

AmeriHealth requires at least 30 days advance written notice to process most updates. For a complete outline of the advance written notice time frames that AmeriHealth requires to process most updates, refer to the Administrative Procedures section of the Provider Manual. Note: If the information submitted is not accurate or complete, it may extend the time frame needed to process the request.

Most changes to basic practice information can be quickly submitted using the Provider File Management transaction on the NaviNet^® web portal. Professional providers may perform the following functions as they relate to their practice:

• Add/Delete a participating practitioner to/from an existing practice
• Add/Delete an address^† (i.e., doing business as [DBA], check, mailing, main, or practice)
• Add/Delete contact name, title, or communication device type/number
• Add/Delete office hours
• Update “Walk-in” acceptance status
• Update Patient and Appointment Options^† (i.e., accepting new patients)
• Update General Practice Availability (i.e., Urgent, Routine Visits, etc.)
• Update Member Access number (i.e., the telephone number that appears on the member’s identification card – which must be the location-specific telephone number for a patient to make an appointment)
• Update Electronic Medical Records (EMR) status
• Update the availability of other clinical staff (i.e., midwife, nurse practitioner, etc.)
• Update office accessibility and services (i.e., handicapped, parking, and communication and language services)

The Provider File Management transaction is not intended for use by facilities, skilled nursing facilities, ancillary providers, or providers contracted with Magellan Healthcare, Inc. (Magellan).

If you are unable to process your request through the Provider File Management transaction, please submit a Provider Change Form. Be sure to print clearly, provide complete information, and attach additional documentation as necessary. The forms can be found and submitted as follows:

• AmeriHealth New Jersey. The Provider Change Form is available here. Completed forms can be faxed to Network Administration at 215-238-2275 or mailed to:

AmeriHealth New Jersey
Attn: Network Administration
P.O. Box 41431
Philadelphia, PA 19101-1431

• AmeriHealth Pennsylvania. The Provider Change Form is available here. Completed forms can be faxed to Network Administration at 215-238-2275 or mailed to:

AmeriHealth
Attn: Network Administration
P.O. Box 41431
Philadelphia, PA 19101-1431

If faxing, please be sure to keep a confirmation of your fax.

The Provider Change Form cannot be used if you are closing your practice or leaving the network. Refer to “Resignation/termination from the AmeriHealth network” in the Administrative Procedures section of the Provider Manual for more information regarding these policies and procedures.

Facility and ancillary providers

As outlined in the Administrative Procedures section of the Hospital Manual, AmeriHealth requires at least 30 days advance written notice to process changes to your information. Note: If the information submitted is not accurate or complete, it may extend the time frame needed to process the request.

Notification of all changes must be submitted in writing to both our contracting and legal departments at the following addresses, or as provided in your Agreement:

AmeriHealth New Jersey:

AmeriHealth
Attn: Deputy General Counsel, Managed Care
1901 Market Street, 43rd Floor
Philadelphia, PA 19103
AmeriHealth New Jersey
Attn: Senior Vice President, Provider Network Operations
259 Prospect Plains Road, Building M
Cranbury, NJ 08512

AmeriHealth Pennsylvania:

AmeriHealth
Attn: Deputy General Counsel, Managed Care
1901 Market Street, 43rd Floor
Philadelphia, PA 19103
AmeriHealth
Attn: Vice President, Total Value Contracting and Reimbursement
1901 Market Street, 27th Floor
Philadelphia, PA 19103

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 advance written notice to AmeriHealth may delay or otherwise affect provider payment. 

If you have questions related to updating your provider information, please email us at providercommunications@amerihealth.com.

*To ensure appropriate setup in AmeriHealth systems, the same time frames also apply to behavioral health providers contracted with Magellan. Behavioral health providers must submit any changes to their practice information to Magellan via their onlineProvider Data Change form by selecting the “Display/Edit Practice Info” link.

^†This function is not available to PCP practices due to possible impacts to capitation and/or incentive programs.

NaviNet^® is a registered trademark of NantHealth.

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