Provider Manuals, Policies and Forms
Manuals and guides
AmeriHealth Caritas North Carolina 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. Please see the Provider Manual Revision Log on page 220 for a complete list of updates.
- Behavioral health utilization management guide PDF
Use this guide to learn more about behavioral health services that require prior authorization.
- Care gaps response form provider guide PDF
The Gaps Response Form functionality allows providers using the NaviNet portal to enter Care Gap resolution data online.
- Claims and billing manual PDF
This guide will help you avoid delays in the processing of your claims. Please see the Claims and Billing Guide Revision Log on page 104 for a complete list of updates.
- Jiva Provider Guide PDF
This guide will help you navigate the Jiva Provider Portal.
- Prior authorization reference guide PDF
Refer to this guide for quick information about services requiring prior authorization and how to submit your request.
- Provider reference guide PDF
Keep this sheet of contact information close by for when you need to give us a call.
- Outpatient specialized therapy (OST) reference guide PDF
Refer to this guide for information about OST services that do and do not require prior authorization and for billing guidance.
Quality Enhancement Program (QEP)
We are committed to helping you deliver the best care to your patients. In an effort to meet our providers' needs and priorities for care delivery, we created the Quality Enhancement Value-Based Compensation Program for participating providers.
The program features a unique reimbursement model intended to reward providers for delivering high-quality and cost-effective care. Providers are rewarded for each member who is attributed to the practice and receives the recommended wellness or preventive care outlined in each of the quality metrics.
- Primary Care Physician Quality Enhancement Program Manual PDF
- Behavioral Health Quality Enhancement Program Manual PDF
- AmeriHealth Caritas North Carolina Clinical Resources
- AmeriHealth Caritas administrative policies
If you have any questions about these materials or about AmeriHealth Caritas North Carolina, call Provider Recruitment at 1-844-399-0474, or contact your Account Executive.
- Advance Directive for a Natural Death PDF
- Advance Instruction for Mental Health PDF
- Health Care Power of Attorney PDF
- Organ/Tissue Donor Card PDF
- Registration Form PDF
- Remove Directive Form PDF
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Grievances and Appeals
Let Us Know (Rapid Response and Outreach Team)
Long-Term Services and Supports (LTSS)
- Delivery Notification Form PDF
- Pregnancy Medical Home Risk Screening Form PDF