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Paper Credentialing

Forms

Application Checklist for Practitioners Not Affiliated with CAQH
Credentialing Application (PA Standard Application)
Completing 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.
Credentialing Warranty Attestation
W-9 Form

Documents & Information

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