Florida | Providers – Amerigroup

News & Announcements

Important Notice for Amerigroup Providers Regarding Durable Medical Equipment, Medical Supply Services and Home Health
Medicare Advantage - Radiation Therapy: Select Brachytherapy, IMRT CPT Codes to Require Prior Authorization
Now available: Send Claims Medical Attachments through Availity
Medicare Advantage - Participating Providers: Bill Medicare Part D for Shingles or Tetanus Vaccination Claims
Medicare Advantage - 2015 Retrospective Medical Record Review Program
Medicare Advantage - Post Service Drug Claim Edits Updated
Medicare Advantage - Precertification Required on Part B New Injectables
ICD-10 Coded Authorizations Accepted Effective June 1.
Medicare Advantage - Provider DSNP Training: July 13, 2015
Medicare Advantage - New Precertification Requirements Effective September 1, 2015
Medicare Advantage - Part B Drug Reminder
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage - Precertification Required for Hemophilia Drugs
Pharmacy Formulary Change Notice Effective April 1, 2015​
Medicare Advantage - Recovery Look-Back Period to Align with CMS
Medicare Advantage - Select Cardiac Services to Be Reviewed
Medicare Advantage - Intensive Outpatient Program Services
Phone number change for Part B benefits
Medicare Advantage: Precertification Required on Four New Part B Injectables
Encourage Medicare Advantage Members to Stay Up-to-Date on Preventive Care
OrthoNet to conduct post-service prepay reviews
Medicare Advantage - ClaimCheck Version 55 Upgraded Effective April 1, 2015
Medicare Advantage: Medicare Update to Pneumococcal Vaccine Policy
Medicare Advantage - Clearing House Helps Ensure Timely and Accurate Claims Payment for Vaccines Covered by Medicare Part D
Department of Children and Families Notification Requirements
Medicare Advantage: Medicare Immune Globulin Home Infusion Therapy Part B Coverage Reminder
Medicare Advantage national coverage determinations
Medicare Advantage: Amerigroup Community Care, Optum Collaborating To Ensure Members Receive Regular Exams, Preventive Screenings
2015 New Provider Orientation Schedule
Medicare Advantage: OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews
Compliance Reminder
New 2015 precertification fax number for skilled nursing, long term acute care and inpatient rehab
Medicare Amerivantage PBM Conversion
Medicare Advantage: Provider Requirements and Medicare Notices
Medicare Advantage 2015 Annual Notice of Change in Products
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
Flu Vaccinations
Medicare Advantage Peer to Peer Changes
Inpatient Readmissions
Encourage Exercise to Prevent Falls
October 2014 Formulary Change Notice​
Patient360 Lets You Access Member Records in a Few Clicks
Florida Healthy Kids Provider Manual Update
Upcoming changes to durable medical equipment precertification requirements
Postponed Upcoming Disbursement Process Changes
Quarterly Pharmacy Formulary Change Notice
Accredo named preferred network for specialty pharmacy
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
We want to hear about your experiences with us.
Spanish Version
Medicare Advantage Members to Receive Monthly Summary Statements
Provider WebEx Orientation Calendar - Long-Term Care
Updated CMS 1500 Form
Availity Announcement and Frequently Asked Questions
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Coming Soon! Enhanced Online Precertification Tool
Provider WebEx Orientation Calendar - Medicaid
Extra Services for SMMC-LTC Members
Attention Behavioral Health Providers – Please respond to our brief survey to keep us informed of the services your practice currently performs.
Medicare Advantage Product Highlights Provider Letter
Quarterly Pharmacy Formulary Change Notice
New Website Password Requirements
Medicare Requirements for Outpatient Therapy Claims

August 1 Changes to Precertification Guidelines
Medication Precertification Tool Available Now
The New Electronic Health Risk Assessment Form
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
AAAHC Survey Information
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
Quarterly Pharmacy Formulary Change Notice
The Medicare Health Outcomes Survey
CMS fact sheets about the rate increase for primary care providers
Latest updates on the transition to ICD-10
Preventing the flu
Our Medicaid ID cards have gone mobile!
We launched our newly designed online provider directory in September. Try it here.

Provider Self-Service

 Provider Resources & Documents

expand Behavioral Health
Screening, Brief Intervention and Referral to Treatment (SBIRT) Flier
Behavioral Health Case Management Flier
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 2
Electronic Data Interchange (EDI)
expand Clinical Practice Guidelines
expand Disease Management Centralized Care Unit
About DMCCU
How to Use DMCCU
expand Enhanced Personal Health Care Program
Measurement Period Handbook
Program Overview
expand EPSDT
Centers for Disease Control - Immunization Schedule
EPSDT Provider Training
expand Forms
Sterilization Consent Form
Functional Assessment Rating Scale (FARS)
Florida Psychotropic Medication Guidelines for Children Younger than 13
Specialized Therapeutic Services Form
BH Initial Review Fax Form - Medicaid
BH Concurrent Review Fax Form - Medicare
expand ICD-10
ICD-10
expand Manuals & QRCs
Florida SMMC-MMA Quick Reference Card
Florida SMMC LTC Provider Manual - Spanish
2015 Medicare Provider Manual Updates
expand Maternal Child Program
Maternity Notification Form
Prenatal Ultrasound Policy
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters
Provider News Issue 1 2013
Provider News Issue 4 2012
Provider News Issue 2 2013
Provider News Issue 4 2014
Provider News Issue 2 2015
expand Pharmacy
Medicare Formulary
Prior Authorization Form
Florida Healthy Kids Preferred Drug List
Managed Medical Assistance (MMA) Summary of Drug Limitations
Managed Medical Assistance (MMA) Drug Criteria
Florida Healthy Kids Formulary
expand Quality Management
HEDIS® 101 for Providers: Improving Quality of Care
expand Quick Tools
Precertification Lookup Tool
Medical Policies
expand Referral Directories
Florida South Medicare Referral Directory
SMMC MMA Referral Directory - East Central
SMMC MMA Referral Directory - South
Florida Healthy Kids Referral Directory - Gulf Coast
DME and Home Health Provider Listing
expand Training Programs
SMMC - MMA Basic Training
Medicaid Provider Orientation
expand Tutorials
Claims Appeals Tutorial
Precertification Request Tutorial
Medication Precertification Tutorial
expand Vendor/Partner Links & Information
HearUSA (Hearing Services)
LabCorp (Laboratory Services)
Quest Diagnostics, Inc. (Laboratory Services)
DentaQuest
Florida Healthy Start Program
Women, Infants, and Children (WIC)
Florida's State Health Online Tracking System (SHOTS)
AIM (Diagnostic and Imaging Service Authorizations)
Florida

Do more online by registering for Provider Self-Service!

Through Provider Self-Service, you can:

  • File and check the status of medical claims
  • Verify eligibility
  • Request precertification
  • Submit a Pharmacy Prior Authorization Request
  • And much more!

To log in, use your Availity ID and password. If you need an Availity ID, visit www.Availity.com to register today.

Visit Frequently Asked Questions about Availity for more information.

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