In accordance with your Provider Agreement (Agreement), the Provider Manual for Participating Professional Providers (Provider Manual), and/or the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital Manual), as applicable, you are required to notify AmeriHealth whenever key provider demographic information changes. AmeriHealth would like to remind you that submitting changes in a timely manner helps to ensure prompt payment of claims, delivery of critical communications, seamless recredentialing, and accurate listings in our provider directories.

Professional providers*

AmeriHealth requires at least 30 days advanced written notice to process most updates if the information submitted is accurate. For a complete outline of the advanced written notice time frames that AmeriHealth requires to process most updates, refer to the Administrative Procedures section of the Provider Manual. Most of the changes to basic practice information can be quickly submitted using the Provider Change Form, available for AmeriHealth New Jersey and for AmeriHealth Pennsylvania.

Note: The Provider Change Form cannot be used if you are closing your practice or terminating from the network. Refer to "Resignation/termination from the AmeriHealth network" in the Administrative Procedures section of the Provider Manual for more information regarding these policies and procedures.

Facility and ancillary providers

As outlined in the Administrative Procedures section of the Hospital Manual, AmeriHealth requires at least 30 days advanced written notice to process changes to your information as long as the information submitted is accurate.

Notice of all changes must be submitted in writing to our contracting and legal departments at the following addresses, or as provided in your Agreement:

Authorizing signature and W-9 Forms

Updates resulting in a change on your W-9 Form (e.g., changes to a provider's name, tax ID number, billing vendor or "pay to" address, or ownership) require the following signatures:

• For professional providers:
  • – Group practices: A signature from a legally authorized representative (e.g., physician or other person who signed the Agreement or one who is legally authorized to bind the group practice) of the practice is required.
  • – Solo practitioners: A signature from the individual practitioner is required.
• For facility and ancillary providers: Written notification on company letterhead is required.

An updated copy of your W-9 Form reflecting these changes must also be included to ensure that we provide you with a correct 1099 Form for your tax purposes. If you do not submit a copy of your new W-9 Form, your change will not be processed.

AmeriHealth will not be responsible for changes not processed due to lack of proper notice. Failure to provide proper advanced written notice to AmeriHealth may delay or otherwise affect provider payment.

If you have any questions about updating your provider information, please contact Customer Service at 1-888-YOUR-AH1 for AmeriHealth New Jersey or at 1-800-275-2583 for AmeriHealth Pennsylvania.

*To ensure appropriate setup in AmeriHealth systems, the same time frames also apply to behavioral health providers contracted with Magellan Healthcare, Inc. Behavioral health providers must submit any changes to their practice information to Magellan via their online Provider Data Change form by selecting the ?Display/Edit Practice Info? link.

Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.