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Paper Credentialing

Please review the application checklist below to ensure you complete and provide all the necessary documents required for the paper credentialing process, in addition to the Credentialing Application, attestation, and W-9 listed below. Please submit all the required documents to AmeriHealth VIP Care via secure email or by fax to 1-717-651-1673.

Credentialing forms

  • Application checklist for providers not affiliated with CAQH (PDF).
  • Credentialing Application (PDF) (PA Standard Application).
    Completing and/or submitting the AmeriHealth VIP Care Credentialing Application does not guarantee participation in the AmeriHealth VIP Care provider network. Note: If you are joining an existing AmeriHealth VIP Care participating group or health care facility and you would like to become a participating provider, please use the Credentialing Application (PDF).
  • Credentialing Warranty Attestation (PDF).
  • W-9 Form (PDF).

Documents and information

  • Frequently asked questions about becoming a participating provider.
  • Frequently asked questions about CAQH.
  • AmeriHealth VIP Care credentialing criteria.

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