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Your Dedicated Partner In Care

We are the industry experts in provider network relations and management, so providers get the tools they need to deliver high quality, patient-centered care. More than 30 years of experience drive our ongoing commitment to improving health care delivery and management for years to come.

As your partner, our goal is to exceed expectations every day. We do this through:

Personal support

Our highly trained Network Management team provides personal services to physicians and office staff, including training and orientations. They answer questions about case management, billing, claims processing and any other topic that affects a practice and its patients.

Claims processing

AmeriHealth Caritas proudly delivers on our promises: We pay your claims in a timely and efficient manner. Plus, we provide multiple submission and payment options for claims processing - both paper and electronic. AmeriHealth Caritas accepts claims via electronic data interchange (EDI), and can pay through electronic funds transfer (EFT). A provider only needs secure Web access to file claims and receive payment electronically.

Provider-insurer collaboration

We understand that a successful managed care program depends on a true collaboration with all providers of care. Providers can count on AmeriHealth Caritas to:

  • Ensure access for members through robust provider networks and telemedicine strategies for rural populations.
  • Collaborate closely with hospitals, primary care physicians (PCPs), specialists and "safety net" providers.
  • Deliver value by conveying the information needed to improve patient care.
  • Offer shared-savings incentives that promote better outcomes and accountable care.

Quality of care

Our goal is to streamline processes and help patients better manage their symptoms, stay well and out of costly emergency rooms. Why are we successful?

  • Patients receive personalized health care information and referrals to community resources to help them deal with chronic health issues.
  • Care management nurses provide education and emotional support to help patients comply with their treatment plans.
  • We support patient care efforts by adhering to HEDIS® standards, conducting patient outreach, arranging for transportation to/from health care services locations and providing 24-hour on-call nurse assistance.
  • We ensure high levels of accuracy in provider data throughout data quality-assurance processes, operational controls, enabling technologies and our data governance strategy.