Kansas | Providers – Amerigroup

News & Announcements

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
Claim Payment Appeal
Precertification Request Form
Blood Lead Testing for High-risk Children
Medical Necessity Appeal Form
BH Concurrent Review Fax Form - Medicaid
Recoupment Notification Form
KanCare Service Authorization Form
PCP Change Request Form (English)
expand Health Homes
Health Homes Action Plan
Providing Leadership for a Successful Health Home
Quality Improvement Flier
expand HPV Education
HPV for Clinicians Continuing Education
expand ICD-10
expand Known Issues Log
expand Manuals & Referral Directories
Kansas Provider Manual
Scion Dental Provider Manual
Billing Guide
expand Maternal Child Program
Program Overview
Prenatal Ultrasound Policy
Healthy Rewards Flier
expand Medical Management Model
Health Education and Wellness
Lock-In Program
expand Newsletters
Provider News Issue 1 2015
Provider News Issue 3 2015
Provider News Issue 1 2016
expand Pharmacy
Kansas Formulary
Medication Therapy Management Pharmacy Locator
Medical Injectables Prior Authorization
Synagis Enrollment Form
expand Quality Management
Medicaid QM Desktop Reference Guide
expand Quick Tools
Precertification Lookup Tool
Medical Policies
expand Training Programs
Pharmacy Provider Education Presentation
Claim Denials Presentation
HCBS Provider Update Call 2016
Nursing Home Webinar
Patient 360 Webinar
How to Avoid Claim Denials
expand Tutorials
Medication Precertification Tutorial
Precertification Status and Appeals Tutorial
Provider Updates: Account Information
Member Information and Panel Listing
expand Vendor/Partner Links & Information
Ocular Benefits (Vision Services)
Access2Care (Nonemergent transportation)
Kansas Dept. of Health and Environment
MultiPlan, Inc.
AAP Clinical Practice Site
ESI Pharmacy Locator Tool
Express Scripts MAC Pricing

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