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.
Provider Manual (PA)
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Introduction (June 2021)
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General Information (May 2023)
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Administrative Procedures (December 2024)
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Fraud, Waste, & Abuse (October 2021)
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Medical Policy & Claim Payment Policy (June 2021)
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Clinical Services – Utilization Management (May 2023)
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Quality Management (July 2024)
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Behavioral Health (December 2024)
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Billing (October 2021)
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Hospitalization and Outpatient Services (October 2021)
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Specialty Programs (May 2023)
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OB/GYN (May 2023)
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Health and Wellness (October 2023)
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Pharmacy (June 2022)
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Appeals - Pennsylvania (August 2024)
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Disclaimer Information (May 2023)