UPDATES TO BEHAVIORAL HEALTH, SECTION 8 ARE IN PROGRESS
AmeriHealth insourced its behavioral health network in 2023 and is now directly contracting with behavioral health providers. Effective January 1, 2024, if you have not yet signed an AmeriHealth Professional Provider Agreement, you will be considered out-of-network for our members.
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)
-
Introduction (June 2021)
-
General Information (May 2023)
-
Administrative Procedures (April 2024)
-
Fraud, Waste, & Abuse (October 2021)
-
Medical Policy & Claim Payment Policy (June 2021)
-
Clinical Services – Utilization Management (May 2023)
-
Quality Management (February 2024)
-
Behavioral Health (October 2021)
-
Billing (October 2021)
-
Hospitalization and Outpatient Services (October 2021)
-
Specialty Programs (May 2023)
-
OB/GYN (May 2023)
-
Health and Wellness (October 2023)
-
Pharmacy (June 2022)
-
Appeals - Pennsylvania (May 2023)
-
Disclaimer Information (May 2023)