AmeriHealth Caritas (DE)Commercial Clinical Policy

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Reference

Prior authorization reference guide

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Manuals and guides</h2>\n<p>AmeriHealth Caritas Delaware offers these reference materials to our providers for use when treating our members.</p>\n<ul>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/provider-manual.pdf.coredownload.inline.pdf">Provider manual (PDF)</a>.<br> This manual will help you and your office staff provide services to our members.</li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/claims-billing-guide.pdf.coredownload.inline.pdf">Claims and billing guide (PDF)</a>.<br> This manual will help you avoid delays in the processing of your claims.</li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/pharmacy-reference-guide.pdf.coredownload.inline.pdf">Pharmacy reference guide (PDF)</a>.<br> Refer to this guide for quick information about services for providers and pharmacies.</li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/provider-reference-guide.pdf.coredownload.inline.pdf">Provider reference guide (PDF)</a>.<br> Keep this sheet of contact information close by for when you need to give us a call.</li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/prior-auth-guide.pdf.coredownload.inline.pdf">Prior authorization reference guide (PDF)</a>.<br> Refer to this guide for quick information about services requiring prior authorization and how to submit your request.</li>\n</ul>\n<p>If you have any questions about these materials or about AmeriHealth Caritas Delaware, call Provider Services at 1-855-707-5818, or <a href="/content/amerihealth-caritas/delaware/language-masters/en/provider/resources/account-executives.html">contact your Account Executive</a>.</p>\n<h2>Forms</h2>\n<h3>Behavioral health</h3>\n<ul>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/bh-sud-child-adolescent.pdf.coredownload.inline.pdf">Behavioral Health and Substance Use Disorder Outpatient Treatment Notification Form Child and Adolescent (Ages 17 and Under) (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/crisis-intervention-notification-request-form.pdf.coredownload.inline.pdf">Crisis Intervention Notification Request Form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/training-and-education/provider-provider-forums.pdf.coredownload.inline.pdf">Provider forum (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/provider-behavioral-health-prior-authorization-request-form.pdf.coredownload.inline.pdf">Prior authorization request form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/provider-substance-use-services-additional-information.pdf.coredownload.inline.pdf">Substance use services additional information form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/tms-request-form.pdf.coredownload.inline.pdf">Transcranial magnetic stimulation request form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/vagus-nerve-prior-auth.pdf.coredownload.inline.pdf">Vagus nerve stimulation prior authorization request form (PDF)</a></li>\n</ul>\n<h3>Complaints</h3>\n<ul>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/claims-dispute-form.pdf.coredownload.inline.pdf">Provider Complaint Form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/provider-claim-refund-form.pdf.coredownload.inline.pdf">Provider Claim Refund Form (PDF)</a></li>\n</ul>\n<h3>Home Health Agency</h3>\n<ul>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/private-duty-nursing-form.pdf.coredownload.inline.pdf">Certificate of Medical Necessity for Private Duty Nursing and Home Health Aid (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/late-and-missed-shift-reporting-form.xlsm">Late and Missed Shifts Reporting Form (XLSM)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/late-and-missed-shift-reporting-form.xlsm">Providers Guide to Late and Missed Shifts Reporting Form (PDF)</a></li>\n</ul>\n<h3>Let Us Know (Rapid Response and Outreach Team)</h3>\n<ul>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/member-intervention-request.pdf.coredownload.inline.pdf">Rapid Response and Outreach Team Member Intervention Form (PDF)</a></li>\n</ul>\n<h3>Maternity</h3>\n<ul>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/bright-start-provider-training-guide.pdf.coredownload.inline.pdf">Bright Start Provider Training Guide (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/bright-start-pump-authorization.pdf.coredownload.inline.pdf">Bright Start Breast Pump Prior Authorization Request Form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/obstetrical-delivery-notification-form.pdf.coredownload.inline.pdf">Obstetrical Delivery Notification Form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/ob-needs-form.pdf.coredownload.inline.pdf">Obstetrical Needs Assessment Form (PDF)</a></li>\n</ul>\n<h3>Prior Authorization</h3>\n<ul>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/pediatric-respite.pdf.coredownload.inline.pdf">Pediatric Respite (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/prior-authorization-request-form.pdf.coredownload.inline.pdf">Prior Authorization Request Form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/prior-auth-guide.pdf.coredownload.inline.pdf">Provider Prior Authorization Guide Physical and Behavioral Health Services (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/pediatric-shift-care-pdn-sdac-request-form.pdf.coredownload.inline.pdf">Pediatric Shift Care (PDN/HHA) Request Form (PDF)</a></li>\n</ul>\n<h3>Working with AmeriHealth Caritas Delaware</h3>\n<ul>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/member/eng/pcp-selection-form.pdf.coredownload.inline.pdf">Primary Care Provider (PCP) Selection Form (PDF)</a></li>\n <li><a rel="noopener noreferrer" target="blank" href="/content/dam/amerihealth-caritas/acde/pdf/provider/resources/forms/sterilization-consent-form.pdf.coredownload.inline.pdf">Sterilization Consent Form (PDF)</a></li>\n</ul>"}}" id="text-8a93ef413d">

Manuals and guides

AmeriHealth Caritas Delaware offers these reference materials to our providers for use when treating our members.

Provider manual (PDF) .

This manual will help you and your office staff provide services to our members.

Claims and billing guide (PDF) .

This manual will help you avoid delays in the processing of your claims.

Pharmacy reference guide (PDF) .

Refer to this guide for quick information about services for providers and pharmacies.

Provider reference guide (PDF) .

Keep this sheet of contact information close by for when you need to give us a call.

Prior authorization reference guide (PDF) .

Refer to this guide for quick information about services requiring prior authorization and how to submit your request.

If you have any questions about these materials or about AmeriHealth Caritas Delaware, call Provider Services at 1-855-707-5818, or contact your Account Executive .

Forms

Behavioral health

Behavioral Health and Substance Use Disorder Outpatient Treatment Notification Form Child and Adolescent (Ages 17 and Under) (PDF)
Crisis Intervention Notification Request Form (PDF)
Provider forum (PDF)
Prior authorization request form (PDF)
Substance use services additional information form (PDF)
Transcranial magnetic stimulation request form (PDF)
Vagus nerve stimulation prior authorization request form (PDF)

Complaints

Provider Complaint Form (PDF)
Provider Claim Refund Form (PDF)

Home Health Agency

Certificate of Medical Necessity for Private Duty Nursing and Home Health Aid (PDF)
Late and Missed Shifts Reporting Form (XLSM)
Providers Guide to Late and Missed Shifts Reporting Form (PDF)

Let Us Know (Rapid Response and Outreach Team)

Rapid Response and Outreach Team Member Intervention Form (PDF)

Maternity

Bright Start Provider Training Guide (PDF)
Bright Start Breast Pump Prior Authorization Request Form (PDF)
Obstetrical Delivery Notification Form (PDF)
Obstetrical Needs Assessment Form (PDF)

Prior Authorization

Pediatric Respite (PDF)
Prior Authorization Request Form (PDF)
Provider Prior Authorization Guide Physical and Behavioral Health Services (PDF)
Pediatric Shift Care (PDN/HHA) Request Form (PDF)

Working with AmeriHealth Caritas Delaware

Primary Care Provider (PCP) Selection Form (PDF)
Sterilization Consent Form (PDF)

Careers

About us

Site map

Non-discrimination/languages help notice (PDF)

AHC Mobile app

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Last Update: <span id="spnPageLastUpdated"></span></p>\n<p>Copyright © 2012-2026 AMERIHEALTH CARITAS DELAWARE. All rights reserved.</p>\n<p>This site contains links to other internet sites. AmeriHealth Caritas Delaware is not responsible for the content of these sites. Please see <a href="/content/amerihealth-caritas/delaware/language-masters/en/terms-of-use.html">Terms of Use</a>, <a href="/content/amerihealth-caritas/delaware/language-masters/en/third-party-data-privacy.html">Third-Party Data Privacy and Educational Materials</a> and <a href="/content/amerihealth-caritas/delaware/language-masters/en/privacy-notice.html">Privacy Notice</a>.</p>\n<p>AmeriHealth Caritas Delaware is owned by the AmeriHealth Caritas Family of Companies, 100 Stevens Drive, Philadelphia, PA 19113.</p>"}}" id="text-ffdbc6d357">

Last Update:

This site contains links to other internet sites. AmeriHealth Caritas Delaware is not responsible for the content of these sites. Please see Terms of Use , Third-Party Data Privacy and Educational Materials and Privacy Notice .

AmeriHealth Caritas Delaware is owned by the AmeriHealth Caritas Family of Companies, 100 Stevens Drive, Philadelphia, PA 19113.

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