Who can become a AmeriHealth Mercy participating provider?

Individuals with appropriate training, licensure and certification who currently:

• Participate in the Pennsylvania Medical Assistance (MA) Program and maintain a valid PROMISe™ Provider Identification Number
• Have one or more offices located in Adams, Berks, Carbon, Cumberland, Dauphin, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Monroe, Northampton, Perry, Pike and York Counties

View the full list of criteria required for participation (see Attachment A)

To enroll in the Pennsylvania MA Program please visit: http://www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/
HandbooksGuidesFormManuals/FAQ/003673180.htm

Is AmeriHealth Mercy actively recruiting for my specialty?

Every request for participation in the AmeriHealth Mercy provider network, whether as a primary care practitioner or as a specialist, is evaluated against the current need to serve and treat our membership in our five county coverage area.

For more information on specialties AmeriHealth Mercy is actively recruiting, please contact the Provider Network Management Department at 1-800-521-6007.

What can I expect during the initial credentialing application process?

Providers must:

• Complete a Pennsylvania Standard Application that includes signature and current date
• Sign and date the attestation form as certification of the accuracy and completeness of the application information and grants AmeriHealth Mercy permission to contact outside agencies to verify or supply information submitted on the application
• Sign and date the Code of Ethics Affidavit
• Submit all license, DEA, board certification, education and training, hospital affiliation information to AmeriHealth Mercy, which will be verified prior to the credentialing/recredentialing decision

As part of the application process, AmeriHealth Mercy will:

• Conduct a site visit and medical record-keeping review upon initial credentialing for all PCP, OB/GYN, and high volume behavioral health providers.  Scores for these reviews must be 90% or greater. 
• Perform medical record reviews on all PCPs and high volume specialists upon recredentialing
• Request information on provider sanctions prior to making a credentialing or recredentialing decision.  Information from the National Provider Data Bank (NPDB), Health Integrity Provider Data Bank (HIPDB), Federation of State Medical Board (FSMB), Medicheck (Medicaid Program exclusions), HHS Office of Inspector General (Medicare exclusions), Federation of Chiropractic Licensing Boards (CIN-BAD), and Pennsylvania State Disciplinary Action report will be reviewed as applicable
• Maintain the confidentiality of, and safeguard the information received for the purpose of credentialing and recredentialing

What can I expect to happen after I submit my application?

After the submission of the application, you:

• After AmeriHealth Mercy receives your credentialing application, it is reviewed for completeness. If pertinent information is lacking, the application will be returned to you for completion. After the initial review of the application, our Credentialing Department verifies your credentials (e.g., license, DEA, board certification, etc.) and presents the information to the AmeriHealth Mercy Credentialing Committee for a final determination on your inclusion in the network. Additionally, an office site visit, with medical record review, is conducted to ensure that your office site and office standards are conducive to adequately treating AmeriHealth Mercy members.
• Have the right to review the credentialing information collected by AmeriHealth Mercy, with the exception of references, recommendations, and peer review-protected information.  When a discrepancy is identified between the information that you submitted and the information obtained during the verification process, the AmeriHealth Mercy Credentialing Department will notify you for explanation and/or correction. 
• Have the right to appeal any credentialing/recredentialing denial within 30 days of receiving written notification of the decision

The process normally takes 60 to 90 days on average.

How can I check the status of my credentialing application?

To check on the status of your credentialing application, simply call AmeriHealth Mercy’s Credentialing Department at 1-800-521-6007 (select prompt 3, followed by option 2).