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Paper Credentialing

Forms

  • Credentialing Application (PA Standard Application)
    Information IconCompleting and/or submitting the AmeriHealth Mercy Credentialing Application does not guarantee participation in the AmeriHealth Mercy provider network
    Note: If you are joining an existing AmeriHealth Mercy participating group or healthcare facility and you would like to become a participating provider, please use the application above. Otherwise, if you would like to become a AmeriHealth Mercy participating provider but are not joining an existing participating group or healthcare facility, please contact Provider Services at 1-800-521-6007 to request a complete Credentialing Application packet, which includes a copy of our Participating Provider Agreement.
 

Documents & Information