Florida | Providers – Amerigroup

News & Announcements

Long-Acting Reversible Contraception Reminder (FHK)
Long-Acting Reversible Contraception Reminder (SMMC MMA)
Medical Policy update - Hyaluronan Injections
2018 Utilization Management Affirmative Statement concerning utilization management decisions
ICS Pharmacy Formulary Change Notice
New Pharmacy Prior Authorization Fax Number Effective April 1, 2018
Elotuzumab to require prior authorization
Behavioral health — precertification requirement changes rescinded
Q3 Medical Policies and Clinical Utilization Management Guidelines Updates
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
Age limits pharmacy formulary change notice effective February 1, 2018
New review process for not otherwise classified drug codes
Effective January 1, 2018, providers will be required to use ProView for credentialing
Quarterly pharmacy formulary change notice effective February 1, 2018
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Mavyret pharmacy formulary change notice effective November 1,2017
Submitting a claim for services during Hurricane Irma
Obtaining a Provisional Medicaid ID
Quarterly pharmacy formulary change notice effective November 1, 2017
Lancets pharmacy formulary change notice effective October 15, 2017
Florida Fee-For-Service (FFS) Medicaid to review all SPINRAZA and EXONDYS 51 prior authorization requests
Q2 Medical Policies and Clinical Utilization Management Guidelines update
Hemophilia factor injections to require prior authorization
Therapy evaluation codes will require precertification as of August 1, 2017
Quarterly pharmacy formulary change notice effective July 1, 2017
Quarterly pharmacy formulary change notice effective August 1, 2017
Q1 Medical Policies and Clinical Utilization Management Guidelines update
Wheelchair component or accessory, not otherwise specified to require prior authorization
Updated Contact Guide
United Home Care case management services update
Frequently Asked Questions Regarding the Merger of Anthem, Inc. Legal Entities in Florida
Managed Medical Assistance (MMA) physician incentive program
Quarterly pharmacy formulary change notice effective May 1, 2017
Adding modifier 52 to the routine anatomic evaluation billing code
Genetic testing services to require prior authorization
Additional information on ClaimCheck® upgrade to ClaimsXten™
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Quarterly pharmacy formulary change notice effective March 1, 2017
Quarterly pharmacy formulary change notice effective February 1, 2017
Continuous interstitial glucose monitoring to require prior authorization
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Elective one and two vessel coronary artery bypass graft to require prior authorization
Quarterly pharmacy formulary change notice effective November 1, 2016
QVAR pharmacy formulary change notice effective September 1, 2016
Quarterly pharmacy formulary change notice effective September 1, 2016
2016 Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
Quarterly pharmacy formulary change notice effective October 1, 2016
Federal nondiscrimination and accessibility update
Update: Certain drugs to require prior authorization
Precertification update for vascular embolization or occlusion services
Quarterly pharmacy formulary change notice effective July 1, 2016
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Prenatal ultrasound reimbursement update
Precertification for knee and spine orthoses effective July 1, 2016
Update on Pharmacy Prior Authorization Submissions
Medical policies update
FL MMA Pharmacy Formulary Change Notice effective April 1, 2016
Quarterly Pharmacy Formulary Change Notice
Custom molded orthotics precertification
Precertification for knee and hip arthroplasty effective May 1, 2016
Precertification for knee arthroscopy effective April 1, 2016
Community Living Support Plan Letter
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Quarterly pharmacy formulary change notice
LTSS Precertification Fax Number Change
SMMC LTC Service Authorization Request Form
Quarterly Formulary Change Notice Effective December 1, 2015
Medicare Advantage - Amerigroup Encourages High-Risk Members to get a Flu Shot
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Scoliosis and spinal deformity medical necessity reviews
State Formulary Changes for SMMC MMA
DME, home health and home infusion therapy prior authorization requirements
Information regarding Univita claims prior to July 28, 2015
Hemophilia drugs authorization changes effective November 15, 2015
Medicare Advantage - New 2016 prior authorization requirements effective January 1, 2016
Medicare Advantage - Part B Updates for Praluent, Repatha and Sylvant
Important Amerigroup Community Care Amerivantage Medicare Advantage changes
Prior authorization required for drugs Entyvio and Cyramza
Medicare Advantage - Precertification update for scoliosis and spine deformity
Behavioral Health: Authorization Requirement Changes Effective October 1, 2015
Cervical Length Screening Guidelines
Home Health Therapy Codes Update Effective September 1, 2015
Important Notice for Amerigroup Providers Regarding Durable Medical Equipment, Medical Supply Services and Home Health
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
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.

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 Provider Resources & Documents

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Assist SUD Screening
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Provider Bulletin 2014, Issue 1
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Clinical Practice Guidelines Matrix
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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
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Recoupment Notification Form
Precertification Request Form
PCP Fax Change Form
Provider Incident Report Form - SMMC MMA/FHK/Comprehensive (SMMC MMA and LTC)
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State Form 3008
State Provider Reimbursement Handbook UB-04
Roster Billing Form
SMMC-LTC Provider Education PPT
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Florida SMMC-MMA Quick Reference Card
Florida SMMC LTC Provider Manual - Spanish
2015 Medicare Provider Manual Updates
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Program Overview
17P Provider Letter
New, separate reimbursement for long-acting, reversible contraception devices
Long-acting, reversible contraception device inventory and separate inpatient reimbursement
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Care Management
Medical Management Model
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Provider News Issue 1 2013
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2017 Quarter 1 Provider Newsletter
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2017 Quarter 3 Provider Newsletter
February 2018 Provider Newsletter
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Medicare Formulary
Managed Medical Assistance (MMA) Summary of Drug Limitations
Managed Medical Assistance (MMA) Drug Criteria
Florida Healthy Kids Formulary
Florida Healthy Kids OTC Drug List
Managed Medical Assistance (MMA) Preferred Drug List Updates
Medical Injectables Prior Authorization
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Medicaid QM Desktop Reference Guide
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Reimbursement Policies
LTSS Precertification Fax Number Change
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SMMC MMA Referral Directory - East Central
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DME and Home Health Provider Listing
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DSNP Plans for 2015 FAQ
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