Provider Manual (PA)

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​​​​​​​​​​​​​​​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)

1. Introduct​ion (June 2021)
2. General Information (May 2023)
3. Administrative P​rocedures (December 2024)
4. Fraud, Waste, & Abuse (October 2021)
5. Medical Policy & Claim Payment Policy (June 2021)
6. Clinical Services –​ Utilization Management​​ (February 2025)
7. Quality Management​​ (July 2024)
8. Behavioral Health (September 2025)
9. Billing​ (September ​2025)
10. Hospitalization and Outpatient Services (July 2025)
11. Specialty Programs​​ (April 2025)
12. OB/GYN (May 2023)
13. Health and Wellness (October 2023)
14. Pharm​​​a​cy​ (June 2022)
    
15. Appeals - Pennsylvania (July 2025)
16. Disclaimer In​formation​ (May 2023)
    

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