Georgia | Providers – Amerigroup

News & Announcements

Behavioral Health Coding Support Update
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
Pharmacy Formulary Change Notice Effective March 1, 2015​​
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 Reimbursement Policy Bulletin 2015, Issue 1
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
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
Reimbursement Policy Reminder
Medicare Advantage: OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews
Individual and Family Therapy Billing and Coding Guidelines
New 2015 precertification fax number for skilled nursing, long term acute care and inpatient rehab
UPDATE: Ordering, Prescribing or Referring NPI Requirement Change
Medicare Amerivantage PBM Conversion
Medicare Advantage: Provider Requirements and Medicare Notices
Medicare Advantage 2015 Annual Notice of Change in Products
PCP Rate Increase Decommission
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
Postponed: Upcoming Disbursement Process Changes
October 2014 Formulary Change Notice​
Patient360 Lets You Access Member Records in a Few Clicks
Upcoming changes to durable medical equipment precertification requirements
CSB Services BH Fee Schedule Update
CORE Services BH Fee Schedule Update​
Quarterly Pharmacy Formulary Change Notice
Important Update Regarding 17-P and Makena
Upcoming Disbursement Process Changes
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Pharmacy first-fill 15-day supply program
Attention Behavioral Health Providers – Please respond to our brief survey to keep us informed of the services your practice currently performs.
Coming Soon! Enhanced Online Precertification Tool
Medicare Advantage Members to Receive Monthly Summary Statements
Availity Announcement and Frequently Asked Questions
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Updated CMS 1500 Form
Quarterly Pharmacy Formulary Change Notice
Medicare Advantage Product Highlights Provider Letter

We would like to inform you of an issue which affected our online formulary from October 13, 2013 to October 31, 2013. During this event, there were some medications which were not visible on the formulary. This matter has since been resolved, and we apologize for any misinformation this occurrence may have caused. The complete formulary can be viewed here.

Medication Precertification Tool Available Now
Provider Notification of Performance Data Use
Quarterly Pharmacy Formulary Change Notice
New Website Password Requirements
Medicare Requirements for Outpatient Therapy Claims
Medical Appropriateness of Tympanostomy/Myringotomy
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
Quarterly Pharmacy Formulary Change Notice
ASH Claims Reminder
Upcoming Changes to Precertification Requirements
The Medicare Health Outcomes Survey
Coming Soon! New Online Medication Precertification Request Tool
CIS Therapy Notice
Annual Quality Management Report
Clinical Practice Guidelines Reminder
Prepayment Reviews for Amerivantage Inpatient Readmission Claims
Important Notice: Medicare Advantage Sequestration
Preventing the Flu
Our Preferred Lab Vendors
VFC Reimbursement and Coding Updates
May 1, 2013, Change to UniCare CPBs & Guidelines
NCQA awards us excellent accreditation status
Our Medicaid ID cards have gone mobile
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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
expand Clinical Practice Guidelines
Clinical Practice Guidelines Matrix
expand Disease Management Centralized Care Unit
Contacting DMCCU
expand EPSDT
EPSDT Reminder Program
expand Forms
Hysterectomy Acknowledgement Form Directions
Request For Authorization - Psychological Testing
Member Missed Appointments Referral Form
BH Initial Review Fax Form - Medicaid
BH Concurrent Review Fax Form - Medicare
expand Georgia Families 360°
expand ICD-10
expand Manuals & QRCs
Planning for Healthy Babies Provider Manual Addendum
Healthy Babies Quick Reference Card
Scion Dental Manual - Georgia Families 360°
2015 Medicare Provider Manual Updates
expand Maternal Child Program
Maternity Notification Form
Prenatal Ultrasound Policy
expand Medical Management Model
Health Education and Wellness
expand Medical Policy
Therapy for Children's Disabilities
expand Newsletters
Provider News Issue 2 2012
Provider News Issue 4 2012
Provider News Issue 3 2014​
expand Pharmacy
Medicare Formulary
Prior Authorization Form
Medicaid Preferred Drug List
Synagis Enrollment Form
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
expand Quick Tools
Reimbursement Policies
expand Referral Directories
Medicaid Referral Directory
expand Training Programs
Cultural Competency
expand Tutorials
Precertification Request Tutorial
Provider Updates: Account Information
Medication Precertification Tutorial
expand Vendor/Partner Links & Information
Caremark (Pharmacy Services) - Medicaid
Avesis (Vision Services)
Georgia Department of Community Health
PeachCare for Kids
Express Scripts Provider Portal - Medicare

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!

How will you access patient information after August 18, 2014?

On August 18, 2014, online member eligibility, benefit and claim status inquiries will only be available at Avoid business disruptions – work with your office staff today to register for and begin using the Availity Web Portal.

Visit Frequently Asked Questions about Availity for more information.

Join Amerigroup's Provider Network

We are currently recruiting providers in the Central and Southwest regions of the state.