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  • Amerihealth Change Providers Form

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ADD DELETE Individual provider ID Last First Middle NPI eff. date / / Taxonomy code Degree BILLING LOCATION Federal tax ID CHANGE OF OWNERSHIP requires NPI certification form Legal business name of new owner Projected effective date of change of ownership / Tax ID number of potential new owner requires a new W-9 Form Please provide a brief explanation of change/request Please mail or fax this change form and supporting document to Network Adminis.

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To connect to the Provider Automated System, call 1-888-YOUR-AH1 (1-888-968-7241).

Need help? Call us at 888-YOUR-AH1 (888-968-7241) (TTY: 711).

Call us at 202-408-4720 or 1-800-408-7511 (TTY/TDD 202-216-9885) to connect to the language line for interpreter services.

Important Telephone Numbers PennsylvaniaCustomer ServiceAmeriHealth HMO/POS Mon. – Fri., 8 a.m. – 6 p.m.1-800-275-2583TTY/TDD Language assistance services are offered through the AT&T Language Line for Members who have difficulty communicating because of an inability to speak or understand English.711Pharmacy Benefits36 more rows

The name Caritas stands for care. We are experts in providing quality health care to people covered by publicly funded programs. These programs include Medicaid, and Louisiana Children's Health Insurance Program (LaCHIP).

Magellan Healthcare, Inc. (Magellan) is a managed care behavioral health care company contracted by AmeriHealth to manage the mental health and substance abuse (behavioral health) benefits for the majority of our Members with HMO, POS, PPO, EPO, and CMM coverage.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232