AmeriHealth Caritas Ohio
AmeriHealth Caritas Ohio has been selected by the Ohio Department of Medicaid (ODM) as a managed care organization (MCO) to serve beneficiaries of Ohio’s Medicaid managed care program across all three regions of the state starting in 2022.
AmeriHealth Caritas Ohio is developing a network of hospital, physician, ancillary, behavioral health, dental, and vision providers. We want to work with dedicated providers like you. Opens a new windowLearn more about our commitment to participating providers (PDF).
Join us, and together we can improve the lives of Medicaid enrollees in Ohio.
Join AmeriHealth Caritas Ohio
To request a Provider Agreement, please complete a Provider Contract Inquiry Form (PDF) Opens a new window and return by email to email@example.com. Contact us by phone at 1-833-296-2259 if you have any questions.
Please complete, sign, and return the following documents to support the execution of your provider contract with AmeriHealth Caritas Ohio. You may complete all documents in a digital format.
- ODM Medicaid Addendum (PDF): This supplements your base provider contract with AmeriHealth Caritas Ohio and runs concurrently with the terms of the base provider contract. The Addendum is limited to the terms and conditions governing the provision of, and payment for, health services provided to Medicaid members.
- ODM Attachments: Choose the most appropriate form for your provider type:
- Attachment A (PDF), for physicians, is needed to identify your capacity and service location.
- Attachment B (PDF), for facilities, is only required for hospital providers to identify services or religious/moral objections.
- Attachment C (PDF), for all providers, is only required when the contract between the managed care entity and the provider includes fewer specialties than the provider identified in the Provider Network Management (PNM) system.
- Provider Data Intake Form for practitioners (PDF)
- Behavioral Health Data Intake Form (PDF)
- Hospital/Facility Data Intake Form (PDF)
- Ancillary Data Intake Form (PDF)
Send us your completed forms through the method most convenient to you:
- Email: Return your forms to your Account Executive at firstname.lastname@example.org or to Provider Network Operations at email@example.com.
- Fax: 1-844-933-0285.
Corporate Provider Network Operations
P.O. Box 406
Essington, PA 19029-0406
Want to learn more? Opens a new windowOur Introduction for Ohio Providers (PDF) includes:
- A more in-depth look at the advantages of joining our growing provider network.
- Expanded explanations of our programs and services.
- Ways you can contact us.