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Provider Notice:
Providers must check state benefits to ensure the request is for a covered benefit. In some cases, state Medicaid contracts or regulatory guidance may supersede both McKesson InterQual Level of Care and Amerigroup medical policy criteria.
Determinations of medical necessity are made on a case-by-case basis. If the request does not meet established criteria guidelines, it will be referred to a licensed physician with the appropriate clinical expertise for review.
Participating providers
-
Behavioral Health
Fax all requests for services that require precertification to:
Inpatient 1-877-434-7578
Outpatient1-800-505-1193
The following markets may fax Behavioral Health Outpatient Requests to the specified fax line below to meet turnaround time (TAT) requirements: Iowa, Louisiana and Texas.
Outpatient 1-866-877-5229
Services billed with the following revenue codes ALWAYS require precertification:
- 0240–0249 — All-inclusive ancillary psychiatric
- 0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
- 0944–0945 — Other therapeutic services
- 0961 — Psychiatric professional fees
- 0632 — Pharmacy multiple sources
Florida
Medicare
Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.
Long-Term Services and Supports
Providers needing an authorization should call 1-877-440-3738.
Georgia
Medicare
Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.
Kansas
Long-Term Services and Supports
All services require precertification by fax to 1-855-225-9937.
Louisiana
There are no additional products or services with special instructions at this time.
Maryland
There are no additional products or services with special instructions at this time.
New Jersey
Medicare
Precertification is not required for physician E&M services for members of the Medicare Advantage Balance plan.
Long-Term Services and Supports
All services require precertification.
- Personal Care Assistants: Call 732-452-6050 and select option 1 or fax requests to 1-888-240-4716
- Adult Medical Day Care: Fax all requests to 1-888-240-4717
New York
Medicare
Precertification is not required for physician E&M services for members of Medicare Advantage Balance and Classic Choice plans.
Long-Term Services and Supports
All services require precertification. Fax requests to 1-866-574-6721 or call 212-563-5570, ext. 66713.
New Mexico
Medicare
Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.
Long-Term Services and Supports
All services require precertification by fax to 1-866-920-8356.
Nevada
There are no additional products or services with special instructions at this time.
Ohio
There are no additional products or services with special instructions at this time.
Tennessee
Medicare
Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.
Long-Term Services and Supports
All services require precertification by calling 1-866-840-4991.
Texas
Medicare
Precertification is not required for physician E&M services for members of the Medicare Advantage Classic plan.
Long-Term Services and Supports
All services require precertification. Follow instructions by service area:
- Austin: Call 512-382-4970 and select option 3 or fax requests to 1-877-744-2334
- Dallas: Fax requests to 1-888-562-5160
- El Paso: Fax requests to 1-888-822-5790
- Lubbock: Fax requests to 1-888-822-5761
- San Antonio: Call 210-737-5700 and select option 3 or fax requests to 1-877-820-9014
Virgina
There are no additional products or services with special instructions at this time.
Washington
There are no additional products or services with special instructions at this time.