Paper Credentialing
Forms
- Application checklist for practitioners (PDF)
- Application checklist for organizational providers (PDF)
- Organizational provider credentialing application (PDF)
- Credentialing application (PDF) (PA Standard Application)
Completing and/or submitting the AmeriHealth Caritas Pennsylvania Credentialing Application does not guarantee participation in the AmeriHealth Caritas provider network
Note: If you are joining an existing AmeriHealth Caritas participating group or health care facility and you would like to become a participating provider, please use the application above (PDF). - Credentialing warranty attestation (PDF)
- W-9 form (PDF)