The AmeriHealth Pennsylvania Provider Network Services (PNS) team is committed to making it easier for our providers to do business with us. 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
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 electronically.
Inquiry submission guidelines
Providers are encouraged to use the self-service tools available through PEAR portal to expedite requests involving verification of member eligibility, claims status, and claim inquiry submission. However, there may be occasions when it is necessary to escalate issues to the PNS team.
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
Step 1: Contact Provider Services at 1-800-275-2583 and follow
the voice prompts. If you do not reach a satisfactory resolution and require
further assistance, please go to Step 2.
| Step 1: Contact Provider Services at 1-800-275-2583 and follow
the voice prompts. If you do not reach a satisfactory resolution and require
further assistance, please go to Step 2.
|
Step 2: Contact your IDS’s designated Network Coordinator.
| Step 2: Complete a Provider Network Services Inquiry
Request form. A Network Coordinator will be assigned to respond
to your inquiry.
|
For claim payment discrepancies
Step 1: Submit your investigation request via PEAR Practice Management
using the Claim Search transaction. If you do not reach a satisfactory
resolution and require further assistance, please go to Step 2.
| Step 1: Submit your investigation request via PEAR Practice Management
using the Claim Search transaction. If you do not reach a satisfactory
resolution and require further assistance, please go to Step 2.
|
Step 2: Contact Provider Services at 1-800-275-2583 and follow the voice prompts. If you do not
reach a satisfactory resolution and require further assistance, please go to
Step 3.
| Step 2: Contact Provider Services at 1-800-275-2583 and follow the voice prompts. If you do not
reach a satisfactory resolution and require further assistance, please go to
Step 3.
|
Step 3: Contact your IDS’s designated Network Coordinator.
| Step 3: Complete a Provider Network Services Inquiry
Request form. A Network Coordinator
will be assigned to respond to your inquiry.
|
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
To request demographic updates/changes, review the procedures outlined on our Provider Data Maintenance page.
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 business days for PNS to fully review and respond to your email request.
Learn more
If you have additional questions, please email our PNS team at pnsproviderrequests@amerihealth.com.