AmeriHealth Caritas VIP Care (Dual-Eligible Special Needs Plan) values excellent relationships with our health care providers. Together, we can work to improve the quality of and access to care for our members.
Use this section of our site to access the resources you need most, including:
Claims and billing
Claim submission/payment information:
- Electronic Claims Submission
- Payer ID: 87406
- Paper Claims Submission:
AmeriHealth Caritas VIP Care
Claims Processing Department
P.O. Box 7125
London, KY 40742-7125
- Change Healthcare customer support is available through online chat, or call 1-800-527-8133, option 2 for assistance.
Other claim information:
- Appropriate usage of claims modifiers 25 and 59 PDF
- Provider Claim Dispute Form PDF
- Waiver of liability form for nonparticipating provider appeals PDF
- Provider Network Management Account Executive contact information
- Provider Services 1-833-433-2177
- Email - You can contact us by using our secure form.
- Coming soon
Training and Education
AmeriHealth Caritas VIP Care (HMO-SNP) provides training and education resources tailored to the needs of our new Medicare providers. We're always striving to offer a variety of different educational opportunities to help our participating providers give quality, expert care to our members.
Our current educational opportunities include:
- Model of Care training
- Cultural competency training
- Resources for Integrated Care — Resources for dualeligibles
- Adult Body Mass Index (BMI) Assessment Claims Coding Chart (PDF)
- Care for the Older Adults (COA) Claims Coding Chart (PDF)
- Care for Older Adults (COA) Form (PDF)
- Clinical resources
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and Health Outcomes Survey (HOS) Information (PDF)
- Diabetes Coding for HEDIS® (PDF)
- Controlling Blood Pressure Claims Coding Chart (PDF)
- HEDIS Incentive Program (PDF)
- Member wellness brochure: Live Well at Any Age — Seven tips to help you live a healthy, happy life as you grow older (PDF)
- Preventive Services Quick Reference Guide
- Promoting Physical Activity Notice (PDF)
- Transitional Care Management With Medication Reconciliation Post-Discharge Notice (PDF)
- Urinary Incontinence Notice (PDF)
Check back frequently, since we'll be updating this section to include the latest information for our providers. Our participating providers can also call AmeriHealth Caritas VIP Care Provider Services at 1-833-433-2177.
AmeriHealth Caritas VIP Care (HMO-SNP) is responsible for the credentialing and recredentialing of its provider network. All providers credentialed by AmeriHealth Caritas VIP Care must also be enrolled with the Medicare program and, as such, must agree to comply with all pertinent Medicare regulations.
AmeriHealth Caritas VIP Care works with the Council for Affordable Quality Healthcare (CAQH) to offer providers a Universal Provider Data source that simplifies and streamlines the data collection process for credentialing and recredentialing.
To obtain information on all the required credentialing documents, in addition to those found in a provider's CAQH record − or for providers who prefer a paper credentialing process − please contact AmeriHealth Caritas VIP Care Provider Services for assistance at 1-833-433-2177 or your local Account Executive.
Additional credentialing information:
For a complete list of the types of providers and facilities that AmeriHealth Caritas VIP Care is responsible for credentialing, see the Provider Manual (PDF) (coming soon).
Practitioner and organizational provider credentialing rights
After submitting the 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 days of the Credentialing Committee or Medical Director review decision.
- To appeal any credentialing or recredentialing denial within 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 anything mentioned above, providers should contact the AmeriHealth Caritas VIP Care Corporate Credentialing department at:
- Care for Older Adults (COA) Coding Chart PDF
- Care for Older Adults (COA) Provider Form PDF
- Controlling Blood Pressure Claims Coding Chart PDF
- Diabetes Coding for HEDIS Form PDF
- HEDIS® Incentive Program PDF
- Medicare Risk Adjustment Overview and Documentation Guidance PDF
- Transitional Care Management with Medication Reconciliation Post-Discharge PDF
- Physical Activity in Older Adults PDF
- Urinary Incontinence PDF
Working with AmeriHealth Caritas VIP Care
If you are not yet a participating provider, and you would like more information on the benefits of partnering with us, contact Provider Services at 1-833-433-2177.