The AmeriHealth Pennsylvania Provider Network Services (PNS) team, is committed to making it easier for our providers to do business with us. Despite the constant challenges within our industry, we are working hard every day to meet the rising needs of our provider network. As you may already be aware, we continue to make great strides in expanding our online self-service capabilities. In addition to our web services, we continue to identify new and improved processes that support our ability to handle a high volume and wide variety of complex issues. 

PNS teams

In an effort to better serve our provider network, PNS aligns its resources into two distinct teams:

• IDS. Our Integrated Delivery System (IDS) team supports practice administrators and payor relations management staff within an IDS, which is a health system that includes integrated hospitals, physicians, ancillaries, and other care facilities.
• Community providers. Our community team supports practitioners or practice administrators (primary care physician [PCP] and/or specialist offices), ancillary and facility providers that are independent of an IDS.

Supported inquiries

As we work to build and sustain a stronger working relationship with participating providers, we want to highlight the types of inquiries that we support for our provider communities:

• claim payment discrepancies for PCP and specialist offices;
• general education regarding products, networks, and procedural guidelines;
• capitation roster and/or payment-related inquiries;
• medical policy and procedural issues related to claim payments;
• long-term care (LTC) panel set-up and member movement coordination efforts;
• practice demographic updates/changes that cannot be submitted via the Provider File Management transaction on the NaviNet^® web portal (NaviNet Open). (Refer to our Demographic Maintenance Guide for more information.)

Inquiry submission guidelines

While we encourage our providers to use the self-service tools available through NaviNet Open to expedite requests involving verification of member eligibility, claims status, and claim inquiry submission, we realize there are occasions when providers may need to escalate their issues to PNS. With that said, PNS is pleased to announce a new process for submitting inquiries to our team for investigation. 

Below are the steps to follow when submitting an inquiry to PNS.

For claim payment discrepancies:

For any of the following inquiry types, please follow the steps outlined below:

• capitation roster and/or payment-related inquiries
• medical policy and procedural issues related to claim payments
• general education regarding products, networks, and procedural guidelines

LTC panel changes

For LTC panel set-up and member movement coordination efforts, please complete a Request to Move Member from PCP to LTC PCP Panel form. 

Demographic changes

Community providers should use the Demographic Maintenance Guide for practice demographic updates/changes. This guide provides the designated methods for the submission of demographic changes.

For IDSs, facilities, skilled nursing facilities, and ancillary providers, notice of all changes must be submitted in writing to our contracting and legal departments, or as provided in your Agreement.

Network Coordinators within PNS serve multiple provider offices in the network. All inquiries regarding your office are important to us. A Network Coordinator will address your questions in a timely manner.

Please allow up to 30 days for PNS to fully research the request and respond to your office.

Learn more

If you have additional questions, please email our PNS team at ahpnsproviderrequests@amerihealth.com.

NaviNet^® is a registered trademark of NantHealth.