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Credentialing

Become a participating provider

To provide services to AmeriHealth Caritas VIP Care members as a participating provider, practitioners must:

  1. Be credentialed by AmeriHealth Caritas VIP Care.
  2. Sign a Participating Provider Agreement (contract).

Contracting

If you are not currently contracted with AmeriHealth Caritas VIP Care and are not joining a group already in our network, please call 1-866-546-7972 to discuss obtaining the appropriate AmeriHealth Caritas VIP Care Provider Agreement.
Note: The credentialing process and contracting process can occur simultaneously.

Credentialing and re-credentialing

AmeriHealth Caritas VIP Care maintains and adheres to all applicable state and federal standards and regulations, the Centers for Medicare and Medicaid Services (CMS) and the Department of Human Services (DHS) requirements, and accreditation requirements governing credentialing and re-credentialing functions. Call 1-800-521-6007 for more information.

The following types of practitioners require credentialing and re-credentialing:

  • Allied health providers (physical therapists, occupational therapists, speech therapists).
  • Audiologists.
  • Certified nurse midwife.
  • Certified registered nurse practitioner.
  • Chiropractors.
  • Dentists.
  • Oral Surgeons.
  • Physicians (D.O.s and M.D.s).
  • Podiatrists.
  • Registered Dieticians.

Select a credentialing process

  • Council for Affordable Quality Healthcare (CAQH) Credentialing.
  • Facility Credentialing/Recredentialing Application (PDF).
  • Paper credentialing.

See additional information:

  • AmeriHealth Caritas VIP Care credentialing criteria.
  • Practitioner credentialing rights (PDF).

Practitioner and organizational provider credentialing rights

After submitting applications, health care providers have the following rights:

  • To review information submitted to support their credentialing applications, with the exception of references, recommendations, and peer-protected information obtained by the plan.
  • To correct erroneous information. When information obtained by the Credentialing department varies substantially from information provided by the provider, the Credentialing department will notify the provider to correct the discrepancy.
  • To be informed, upon request, of the status of their credentialing or recredentialing applications.
  • To be notified within 60 calendar days of the Credentialing Committee or Medical Director review decision.
  • To appeal any credentialing or recredentialing denial within 30 calendar days of receiving written notification of the decision.
  • To know that all documentation and other information received for the purpose of credentialing and recredentialing is considered confidential and is stored in a secure location that is only accessed by authorized plan associates.
  • To receive notification of these rights.

To request any of the above, providers should contact the AmeriHealth Caritas VIP Care Corporate Credentialing department at:

AmeriHealth Caritas
Attn: Credentialing Department
200 Stevens Drive
Philadelphia, PA 19113

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