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PRACTITIONER INFORMATION FORM
Network Need: Internal Use OnlyPlease Print Update No New
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Amerihealth Caritas District of offers managed care services.
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Providers and organizations participating in the Amerihealth Caritas network are required to file.
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The purpose of the form is to report important information about services provided and costs incurred within the Amerihealth Caritas network.
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Information such as service codes, quantities, and associated costs must be reported on the form.
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