AmeriHealth Caritas DC
Overview
DC-region Medicaid managed-care plan. Shows up dominantly in the DC and Maryland enrollment pipelines (largest single-payer volume driver for Maryland PM Pediatrics lines).
Active Work / Processes
- Recent PDIF update — AmeriHealth Caritas DC updated its Provider Data Intake Form; Medallion’s team is now submitting on the new form (week of 2026-04-13).
Pain Points / Open Issues
- Dual Medicaid approval required (DC + MD) — AmeriHealth requires both DC Medicaid AND Maryland Medicaid enrollment approvals before they’ll process an application. Many PMP applications were originally submitted with only one of the two approvals and subsequently rejected. Expect resubmission spike in the week following 2026-04-13 as the pipeline is rebuilt with dual approvals.
Key Facts
- Top payer for PM Pediatrics in MD (majority of ~115 Maryland lines) and in DC (~36 DC lines).
- Also cited volume driver in DE (~28 lines) and PA (part of ~41 lines with Independence).
- Rejects applications missing either DC or MD medicaid approval.
Related Customers
Source History
- 2026-04-13 — PM Peds Aged Line Review — dual-medicaid requirement + PDIF update