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COVID-19 News and Resources

COVID-19 update: Amerigroup District of Columbia, Inc. suspends select prior authorization rules and announces significant policy adjustments in response to unprecedented demands on health care providers (updated May 30, 2020)
COVID-19 update: Guidance for telehealth/telephonic care for behavioral health services
Listen now! Webinar recording available from Amerigroup, District of Columbia, Inc. for network providers on SBA loans and other federal relief programs in response to COVID-19
COVID-19 information from Amerigroup District of Columbia, Inc. (April 22, 2020)
Federal resources available for health care providers and employers in the federal CARES Act
Guidance for MCOs on Outreach Messaging for Well-Child Visits During DC Public Health Emergency
Behavioral Health Transformation Demonstration Program: HIE Participation Requirements for IMDs
Updates to the Laboratory Billing Codes and Reimbursement Rates for COVID-19 Testing
COVID-19: extra help organizations
Strong Start DC Early Intervention Program (DC EIP) and Telemedicine during COVID-19
Office of the Mayor Stay at Home Order (March 30, 2020)
Medicaid Beneficiary Coronavirus (COVID-19) Frequently Asked Questions (March 27, 2020)
Temporary Eligibility Policy Changes for Medicaid, Children’s Health Insurance Program (CHIP), Alliance, and Immigrant Children’s Programs in Response to Public Health Emergency COVID-19
Updated Priorities for Testing Patients with Suspected COVID-19 Infection and Updated Prioritization of Contact Tracing by DC Health
Recommendations for Conserving the Supply of Personal Protective Equipment in DC
Updates and Frequently Asked Questions about Public Benefits during the Coronavirus (COVID-19) State of Emergency (March 22, 2020)
Telemedicine Provider Guidance
Public Health Emergency Guidance on Medicaid-Reimbursable Telemedicine Services: Allowance for Audio-Only Visits and HIPAA
Coronavirus Small Business Resources
Laboratory Billing Codes and Reimbursement Rates for COVID-19 Testing (March 20, 2020)
Novel Coronavirus 2019 (COVID-19): Emergency Authorization of a 90- day supply for maintenance medications and 30- day supply for non-maintenance medications (March 20, 2020)
Telemedicine Provider Guidance (March 18, 2020)
Recommendations on Limitations of Elective and Non-Urgent Medical and Dental Procedures due to COVID-19 (March 17, 2020)
Recommendations on Limitations of Elective and Non-Urgent Medical and Dental Procedures due to COVID-19 (March 17, 2020)
Emergency Extension of Medicaid Eligibility due to COVID-19 (March 17, 2020)
Guidance Related to Coronavirus: Individuals with Disabilities Education Act (IDEA), Part C Provision of Early Intervention Services (Strong Start) (Issued March 14, 2020)
Medicaid-Reimbursable Telemedicine Services: Reimbursement for Healthcare Services Delivered to a Beneficiary in their Home via Telemedicine (March 13, 2020)
Telemedicine Provider Guidance (March 13, 2020)
HCPCS BIlling Code for Coronavirus Lab Test (March 3, 2020)

News & Announcements

InterQual 2020 update
Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
New behavioral health discharge call-in line
February 2020 Medical Policies and Clinical Utilization Management Guidelines update
Quarterly pharmacy formulary change notice effective May 1, 2020
Medical Policies and Clinical Utilization Management Guidelines update - November 2019
Modifier use reminders
Clinical Criteria Web Posting February 2020
2020 affirmative statement concerning utilization management decisions
MCG care guidelines — 24th edition
Electronic submission is preferred method for requesting pharmacy prior authorization
Acquisition of Beacon Health Options
Recommendations on Limitations of Elective and Non-Urgent Medical and Dental Procedures due to COVID-19 (March 17, 2020)
Medicaid-Reimbursable Telemedicine Services: Reimbursement for Healthcare Services Delivered to a Beneficiary in their Home via Telemedicine
COVID-19 information from Amerigroup District of Columbia, Inc. (March 13, 2020)
Prior authorization requirements: new 2020 codes for coverage and precertification
November 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Incorrect Claims Payments Alert
Clinical Criteria Web Posting December 2019
CORRECTION - Precertification update for Truvada and Descovy
Clinical Criteria Web Posting November 2019
Availity - Provider FAQ
Availity Provider Notification
Coding tip for psychological and neuropsychological testing
New specialty pharmacy medical step therapy HAE requirements
New Specialty Pharmacy Medical Step Therapy ESA/CSF Requirements - Effective March 1, 2020
Revision to evaluation and management services — over-coded services postponed
Quarterly pharmacy formulary change notice effective February 1, 2020
Behavioral Health Areas of Expertise Profile survey
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update
InterQual 2019.1 update
Multiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update
Precertification update for Truvada and Descovy - Effective 1/6/2020
Reminder: Physical and occupational therapy reviews
Clinical Criteria Web Posting September 2019
August 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Clinical Criteria Web Posting August 2019
Quarterly pharmacy formulary change notice effective November 1, 2019
Clinical Laboratory Improvement Amendments
Prenatal service third-party liability change
Drug Screen Testing Update
March 2019 Clinical Utilization Management Guidelines
June 2019 Medical Policies and Clinical Utilization Management Guidelines Update
March 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Clinical Criteria Web Posting July 2019
Prior authorization requirements changes effective November 1, 2019
Home-delivered meals aim to reduce risks and hospital readmissions
InterQual 2019 update
Semi-Annual Cost of Care Review
Customization for IP Cancer Therapy
Evaluation and management services -over-coded services
Review of information on file for your practice
Clinical Criteria Web Posting Q1 2019
Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy
Clinical Criteria Web Posting Q2 2019
Quarterly pharmacy formulary change notice effective August 1, 2019
January 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Facility reimbursement for early elective deliveries
Unspecified Diagnosis Code Update
Prepayment clinical validation review process
Wound care treatment prior authorization request update
Healthy students are better learners
Quarterly pharmacy formulary change notice part II effective May 1, 2019
How to Contact IngenioRx Specialty Pharmacy Beginning May 1, 2019
2019 Utilization Management Affirmative Statement concerning utilization management decisions
New Specialty Pharmacy Medical Step Therapy Requirements
Quarterly pharmacy formulary change notice effective May 1, 2019
Pharmacy benefit manager change to IngenioRx
Correction: Cervical length measurement by transvaginal ultrasound
November 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Clinical Criteria updates
September 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Medical necessity review for appropriate level of care
Quarterly pharmacy formulary change notice effective February 1, 2019
July 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Reminder:State Medicaid Program Enrollment Requirement
Cultural competency and patient engagement
Long-Acting Reversible Contraceptive Update
Electronic data interchange gateway update
Prior authorization requirements for Sublocade
Prior authorization requirements for Subcutaneous Implantable Defibrillator system
Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
Prenatal formulary change notice effective August 1, 2018
Out of State Medicaid Enrollment Exceptions
Medical Necessity Criteria Changes
Cervical length measurement by transvaginal ultrasound
State Medicaid Program Enrollment Requirement - All Providers
Quarterly pharmacy formulary change notice effective October 1, 2018
Prior authorization requirements for Interferon beta-1a
Prior authorization requirements for Somatrem
May 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Medical Policies and Clinical Utilization Management Guidelines update - March 2018
Medical Policies and Clinical Utilization Management Guidelines update - January 2018
Quarterly pharmacy formulary change notice effective August 1, 2018
Amerigroup District of Columbia, Inc. adopts 22nd edition of the MCG care guidelines
Prior authorization requirements for Cabazitaxel
Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)
Zepatier, cough and cold pharmacy formulary change notice effective June 1, 2018
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
Services requiring prior authorization
ICS pharmacy formulary change notice update: effective April 15
Lower extremity vascular intervention codes require prior authorization
Prior authorization requirements for Darzalex drug
Electrical stimulation device to require prior authorization
Quarterly pharmacy formulary change notice effective May 1, 2018
Prior authorization requirement update for Mylotarg
Q4 Medical Policies and Clinical Utilization Management Guidelines Updates
Meningococcal vaccine update
ICS Pharmacy Formulary Change Notice
Medical Policy update - Hyaluronan Injections
Eight injectable drugs will require prior authorization
AIM Musculoskeletal Guidelines
Elotuzumab to require prior authorization
Welcome to the provider network family
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
Age limits pharmacy formulary change notice effective February 1, 2018
Quarterly pharmacy formulary change notice effective February 1, 2018
Effective January 1, 2018, providers will be required to use ProView for credentialing
New review process for not otherwise classified drug codes
Alliance Behavioral Health Inpatient and Outpatient Benefits
McKesson criteria disclosure
UPDATE No/Late Notification Process
Transplant Service Request Instructions
February 2017 UPDATE to Medical Policies and Clinical Utilization Management Guidelines
Genetic Testing Services
UPDATE to Medical Policies and Clinical Utilization Management Guidelines
Prior Authorization Update for Custom Shower Chairs

Provider Self-Service

Do more online through Provider Self-Service!

  • File and check the status of medical claims
  • NEW — Submit Claims Payment Disputes electronically via Availity
  • Verify eligibility
  • Request precertification via the Interactive Care Reviewer (ICR)
  • Conduct an inquiry on the status of any precertification request via ICR
  • For more information on ICR such as features, support or training go to
    ICR-Help
  • Submit a Pharmacy Prior Authorization Request
  • And much more!

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Vision & Dental

If you are requesting one of the services listed below, do not continue with your request through the Availity portal:

Vision Services: Avesis
Provider Services: 1-833-554-1013
Member Services: 1-833-554-1012

Dental Services: DentaQuest
Provider Services: 1-844-876-7919
Member Services: 1-844-876-7918



Provider Resources & Documents
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Pharmacy Prior Authorization Form
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State Hepatitis C Policy: Daklinza
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Prior authorization update for 17 Alpha-hydroxyprogesterone caproate/Makena®
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