As of July 17, 2017, AmeriHealth updated its requirements related to credentialing and contracting providers who render services to our members. As part of the update, providers must have completed all residency/fellowship training for the specialty in which they are applying in order to be considered for credentialing or contracting with AmeriHealth. AmeriHealth will only accept applications from fellows if they have completed residency training in the specialty for which they are applying.
Example 1: An endocrine fellow wants to be credentialed in internal medicine.
Residency/Training Credentialing criteria Application statusEndocrine fellowship not completed BUT internal medicine residency completed Fellow meets all credentialing and contracting requirements for internal medicine Approved for internal medicine only to the extent the fellow meets other credentialing and contracting requirements Example 2: An endocrine fellow has completed internal medicine training and wants to be credentialed in endocrinology.
Residency/Training Credentialing criteria Application statusEndocrine fellowship not completed; internal medicine residency completed Credentialing criteria not met because endocrine residency/fellowship is not completed Denied
Note: This is an update to the April 6, 2017, Partners in Health UpdateSM article, Our policy on credentialing providers in training, which stated it was our policy to not credential providers currently in training.
Credentialing process
Any professional provider interested in participating in our network must complete and return a credentialing application kit. You can simplify this process by using the Council for Affordable Quality Healthcare?s (CAQH) online credentialing application: CAQH ProView™.
A completed, signed, and dated application includes, but is not limited to:
- work history for immediate previous five years from the date the application was signed, including month and year, with a written explanation of gaps greater than six months;
- education and training completed (e.g., medical school, residency training, and fellowships);
- statement of chemical dependency or substance abuse;
- loss or limitation of license or felony convictions;
- loss or limitation of hospital privileges or disciplinary action;
- reasons for any inability to perform the essential functions of the position, with or without accommodation;
- an attestation to the correctness and completeness of the application;
- a signed and dated Authorization for Release of Information (credentialing warranty).
A complete list of credentialing criteria applicants must adhere to is available for AmeriHealth New Jersey and AmeriHealth Pennsylvania.