Kansas | Providers – Amerigroup

News & Announcements

Present on admission indicator for external cause of injury diagnosis codes
Behavioral health/substance use disorder therapy services not allowed in nursing facility
Hospital Billing Codes Update
Extraordinary Funding Provider Notificaton
Services Billable by Speech Therapists
Prior Authorization Notice: Use of Stimulant Medications for Members 18 Years of Age or Older
Prior Authorization Notice: Use of Stimulants and Other ADHD Agents in Children 3 Years of Age or Younger
Preset limit increase for T1017
Update to drug amount discarded/not administered modifier
Medical team conference codes as content of service
Coverage of additional botulinum toxin procedure codes
Pharmacy Dose Optimization Program Update
Prior Authorization Notice: Maximum Daily Dose Limits for Stimulants and Other ADHD Agents
Billing Guide
Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
July 2016 HCPCS updates
Unacceptable Primary DX Codes
Prior authorization required for antipsychotic drugs prescribed to members 13 years of age or younger
Prior Authorization Notice
CMHCs and HCBS/SED rate configuration error
Requests for authorization of autism waiver services
Services always considered content of service REVISION
Federal nondiscrimination and accessibility update
CDC Influenza Update
Biosimilar Products - Modifier ZA
Prior Authorization Required Notice Concurrent Antidepressants
2016 Budget Shortfall Reduction
Changes to home and community-based services client obligation process
Precertification update for vascular embolization or occlusion services
Prior Authorization for Certain Unlisted Codes
Health Home Program Closure Update
Clarification to corrected claims process
Provider Update: TPL Cost Avoidance for HCBS Codes
CMHC Billing Guidelines
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Provider Update:Anesthesia Billing Services
Update: Preauthorization changes for K0108
Governor Sam Brownback takes action to balance the Kansas budget
Precertification for knee and spine orthoses effective July 1, 2016
Prior authorization notice - SSRIs
Prior authorization notice - SNRIs
Services always considered content of service
Deletion of G-codes with 2016 annual HCPCS
Provider Update: Prior Authorization Required Notice
Prior authorization for hospice services
KAN Be Healthy (KBH) – Early Periodic Screening, Diagnosis and Treatment (EPSDT) updates
Update: Coverage of G-codes differentiating RN and LPN skilled nursing visits
April 2016 HCPCS updates
Coverage of unlisted codes – additional codes
Our pharmacy prior authorization process for drugs used to treat mental health issues
Prior Authorization Criteria for Maximum Daily Dose Limitations of Antipsychotic Agents
Prior Authorization Criteria for Members Receiving Multiple Benzodiazepines
Update on Pharmacy Prior Authorization Submissions
New claim reconsideration and appeal process
KanCare All MCO Training
Psychiatric Residential Treatment Facility (PRTF) process update
Overnight respite rate change
Screening, brief intervention and referral for treatment (SBIRT) certification and attestation process
Medical policies update
Enhanced care services
Prior Authorization Required Notice
Revised Hospital Rates - April 2016
Enhanced Availity eligibility and benefits inquiry
Personal Care Services updates
Provider Update: Prior Authorization Required Notice
Diagnosis codes related to covered obstetrical (OB) sonograms
Reimbursement of donor human breast milk
Services billed during the month of death
Developmental therapy services update
DRG Retro Rate change
HCPCS 2016 updates
Clinical Laboratory Improvement Amendments (CLIA) requirements
Facility Charges (G0463) Update
KAN Be Healthy Program Resources
Billing Guide for Newborn Services
Prior Authorization Required Notice
H2017 authorization changes
Prior Authorization Required Notice
Transportation service to in-patient psychiatric facilities
Precertification for knee and hip arthroplasty effective May 1, 2016
Precertification for knee arthroscopy effective April 1, 2016
2016 Anesthesia Conversion Factor Update
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Revised date of exclusion of facility outpatient claims increase
Provider Update for Procedure H0032-HA
Urinalysis restrictions for pregnancy related diagnosis codes
Health Home Partner Billing Update
Breastfeeding, Breast Pump Info and FAQs
Sleep Cycle Support Service
2016 Anesthesia Conversion Factor
Non-coverage of facility charges for Peer Group 1 hospitals
RHCs and FQHCs billing for Vaccines
Traumatic brain injury and transitional living skills
Coverage of G-codes differentiating registered nurse and licensed practical nurse skilled nursing visits
Fiscal year 2016 Medicare severity diagnosis-related groups weights and rates
October 2015 updates
Human papillomavirus (HPV) vaccine update
Clarification of outpatient rate increase for out of state facilities, Kansas state-owned and teaching hospitals
Hospice Services Billing Changes
POS for Services in OP
Developmental Therapy services
Money Follows the Person transitional services
Date of Svc for DME, Prosthetics & Orthotics Claims
RETRACTION: Prior authorization required for drugs Entyvio and Cyramza
CMHC Billing Guidelines
Scoliosis and spinal deformity medical necessity reviews
Inpatient Interim Hospital Billing
Dose Optimization Program Update Effective November 9, 2015
Changes in Substance Use Disorder rates, units and procedure codes
Oct. 8 Preadmission Screening Process Changes Training
ICD-10 Diagnosis for Home and Community Based Services and Waiver Service Claims
Fraud, Waste and Abuse
ICD-10 WebEx Orientation Schedule
Avoiding Claim Denials Webinar Schedule Fall 2015
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Preadmission screenings for behavioral health - revised
Change to reimbursement for targeted case management (T1017) for CHIP members
Reconciliation due to 2014 DRG rate adjustment
Behavioral Health: Authorization Changes Effective November 1, 2015
Outpatient hospitals and ambulatory surgical centers billing for physician services
Cervical Length Screening Guidelines
HCBS Provider Update Call
Dose Optimizaton Program Begins September 7, 2015
Certain Unlisted Codes Will Now Be Considered for Coverage
Now available: Send Claims Medical Attachments through Availity
Medical criteria update
Lock-In program update
Bone-anchored hearing aid (BAHA) billing clarification
Revised diagnosis related group rates and weights for fiscal year 2015
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
ICD-10 Coded Prior Authorizations Accepted Effective June 1
Prior authorization for I/DD HCBS waiver services and I/DD TCM services
E&M codes billed with respiratory services
Sterilization policy and consent form reminder
Express Scripts Prior Authorization Tool Available June 1
Positive behavioral support (PBS) services
Annual member rights notification
Retroactive eligibility authorization process
Health Home Partner panel listing user guide
Clinical Laboratory Improvement Amendments (CLIA) requirements
Billing for Certain Value Added Benefit Services
Anesthesia billing
PRTF-other services billing revised
Changes to Ordering, Referring, Prescribing Requirements Effective April 1
Implementation of CPT Category II codes
Pharmacy Benefit Manager Change to Express Scripts Effective April 1, 2015
Paper claims submission process changes
PCP Rate Increase Decommission
Community mental health center (CMHC) billing guidelines for modifiers and rendering providers
Ordering, referring and prescribing NPI requirements due to the Affordable Care Act
Attending Provider NPI and Institutional Claims
Upcoming changes to durable medical equipment precertification requirements
Prespecific Limits for Behavioral Health Services
Postponed Upcoming Disbursement Process Changes
Amerigroup Client Obligation Review and Status Update
Availity Announcement and Frequently Asked Questions
Hearing Aid Return Policy
Transition Care Management
CMS 1500 Deadline Extension
Attending Provider Billing with Nursing Homes
Availity Announcement and Frequently Asked Questions
KanCare Health Home Program and Survey
Updated CMS 1500 Form
Medicaid Electronic Health Records (EHR) Incentive Program Attestation Requirements
Changes to Precertification Utilization Review
Anesthesia Claims Update for Eye-Related Procedures
Billing Guidelines for Providers of Intellectual/Developmental Disability Waiver Services
Enrollment Update for FQHCs, RHCs and Hospices
Intellectual/Developmental Disability Provider Orientation Sessions
Intellectual/Developmental Disability Waiver Services Begin February 1, 2014
Preventing the Flu

Provider Self-Service


 Provider Resources & Documents

expand Behavioral Health & Screening Tools
Patient Health Questionnaire (PHQ-9)
Mood Disorder Questionnaire
Case Management Solutions
expand Claims Submission and Reimbursement Policy
Taxonomy Cross Reference Tool
UB-04 Claim Form
Resolving Your Claims Issues
Provider Bulletin 2014, Issue 2
Electronic Data Interchange (EDI)
expand Clinical Practice Guidelines
expand Disease Management Centralized Care Unit
How to Use DMCCU
expand Emergency Transportation Billing
expand EPSDT
EPSDT Toolkit
EPSDT Provider Training
expand Find Your Provider Representative
List of Provider Representatives
expand Forms
Refund Notification
Practice Profile Update Form
Claims Correspondence Form
BH Initial Review Fax Form
Psychological Testing Request Form
Hospice Precertification Request
State Eligibility Tracking Form
PCP Change Request Form (Spanish)
Autism Waiver Outpatient Treatment Request Form
Behavioral Health Discharge Note
expand Health Homes
Action Plan Instructions
Health Action Plan Goal Setting​
expand HPV Education
You Are the Key to HPV Cancer Prevention
Human Papillomavirus (HPV)
expand ICD-10
expand Known Issues Log
Known Issues Log
expand Manuals & Referral Directories
Ocular Benefits KanCare Manual
Quick Reference Card
Kansas Referral Directory
expand Maternal Child Program
Maternity Notification Form
17P Notification
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters
Provider News Issue 1 2013
Provider News Issue 2 2015​
Provider News Issue 4 2015
Provider News Issue 2 2016
expand Pharmacy
Pharmacy Tools
Kansas Preferred Drug List (PDL)
Spend Down Information
Natn'l Drug Code FAQs
Pharmacy Prior Authorization Forms
expand Quality Management
Quality improvement summary​
expand Quick Tools
Reimbursement Policies
expand Training Programs
Orientation Bookmark - Provider Manual
General Provider Orientation
Provider Orientation Schedule 2016
Cultural Competency Training
Availity Demonstration
Indian Services Webinar
Extraordinary Funding Webinar
Cultural Competency Toolkit
expand Tutorials
Health Risk Assessment Lookup Tool Tutorial
Precertification Requests Tutorial
Member Information and Panel Listing Guide​ Tutorial
Claims Appeal Tutorial
expand Vendor/Partner Links & Information
LabCorp (Laboratory Services)
Quest Diagnostics, Inc. (Laboratory Services)
Kansas Medical Assistance Program
Scion Dental (Dental)
AIM (Diagnostic and Imaging Service Authorizations)
Express Scripts Prior Authorization
Express Scripts Provider Portal

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