​​​​​We continue to receive a high volume of claim review requests inappropriately sent to the member appeals fax number.

Note: Misdirected requests will delay processing.

DO NOT use the appeals fax number to submit medical records not related to a member appeal or to request the status of a Claim Investigation.

Providers and their third-party vendors must adhere to the proper submission channel for claim review requests. Please work with your third-party vendors to ensure they are aware of the proper submission procedures.

Process for submitting claims-related issues

• Use the Practice Management application on the Provider Engagement, Analytics & Reporting (PEAR) portal to submit a Claim Investigation request via the Claim Search transaction.
• Review the Claim Search & Investigation user guide in the PEAR Help Center for assistance.

Process for submitting provider appeals

Provider appeal requests must be mailed to AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, or AmeriHealth Administrators as outlined in the Appeals section of the Provider Manual for Pennsylvania or New Jersey or the Clinical Services – Utilization Management section of the Hospital Manual.​

IMPORTANT: Do not use the member appeals fax number unless you are submitting an appeal on the member's behalf.

Examples of when the fax number can be used include:

• Provider appeals on behalf of the member with a valid member consent form.
• Expedited preservice appeals on behalf of the member.
  

Thank you in advance for ensuring the appropriate channel is used when submitting future requests.

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