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.
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.