Kansas | Providers – Amerigroup

News & Announcements

Amerigroup Kansas, Inc. fights opioid addiction: Extension for Community Healthcare Outcomes and Quality Medication-Assisted Therapy
May 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Overnight respite care for members with intellectual and developmental disabilities
New pharmacy prior authorization retail fax number
UPDATE: Podiatry services coverage in adults
Prior authorization notice
Removal of prior authorization for hospice codes
Lower extremity vascular intervention codes require prior authorization
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
2018 Utilization Management Affirmative Statement
Q4 Medical Policies and Clinical Utilization Management Guidelines Updates
Prior authorization notice
Correction for HEDIS Maternity Attestation
AIM Musculoskeletal Guidelines Notice
Elotuzumab to require prior authorization
Podiatry services coverage in adults
Q3 Medical Policies and Clinical Utilization Management Guidelines Updates
New review process for not otherwise classified drug codes
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Category II Codes for HEDIS
Effective December 1, 2017: prior authorization for genetic testing required
Substance use disorders in pregnancy and neonatal abstinence syndrome
Demographic changes reminder
Documentation and communications reminders
Q2 Medical Policies and Clinical Utilization Management Guidelines update
Q1 Medical Policies and Clinical Utilization Management Guidelines update
2017 Interqual Criteria
Autism provider recruitment
Level of Care Required for Long-Term Care Payment
Provider Update: Prior Authorization Required Notice - Effective July 1, 2017
HCPC Changes April 2017
Final rule changes to KanCare home health coverage
Psychiatric residential treatment facilities reserve days
Appeal Changes
Hearing tests by Hearing Instrument Specialists
Genetic testing services to require prior authorization
Coverage of Newborn Diagnosis Codes Range Z38
PRTF TPL Cost Avoidance
CLIA Editing for Code G0499
CMS Revision April 2017 NCCI MUE Editing
J0840 for hospital provider types
Radiation therapy codes
Coverage of Autism Services
CMS revision to January 2017 NCCI/MUE editing for 99151-99153
Clarification: Medicare crossover claim processing changes
Providers experiencing G38 denials
Intrauterine device rate change
FDA approved CLIA waived tests
2017 anesthesia conversion factor
March 2017 ICD-10 implementation
KMAP HCBS Physical Disability Manual
National Correct Coding Initiative and Medically Unlikely Edits quarterly updates
Modifier JW — drug amount discarded
Notification process reminder
2017 health care procedure code changes
Adverse incident reporting to Kansas Department of Aging and Disability Services
MCR Crossover Claim Processing Changes
Additional information on ClaimCheck® upgrade to ClaimsXten™
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Crisis and exception policy
Prior Authorization Required Notice - Effective April 1, 2017
Join us and the CDC to learn new HPV Vaccine Recommendations. 2 sessions: February 14 or 16, 2017
General hospital updates on rates
Implementation of residential billing policy
Hospital billing: procedure code dates versus admission dates
Coverage of 99211 when rendered by registered nurse employed by community mental health center
Coverage of Catheter Aspiration 31720
Personal care services and limitations
Enhanced care services - legally responsible individual, capable person
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Notification of change to inpatient claim submission requirements
Provider Update: Prior Authorization Required Notice
Hospital budget shortfall payment reduction clarification 3
Noncoverage of FluMist
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Providers billing for flu vaccine
Duplicate claim editing for community mental health centers
Clarification on billing 41899 - unlisted procedure for dentoalveolar
Requests for authorization of Traumatic Brain Injury waiver therapy services
Billing for other services for members in psychiatric residential treatment facilities
October updates
Budget shortfall payment reduction - second clarification
Procedures that do not require the Sterilization Consent Form
Budget shortfall payment reduction - clarification
Home- and Community-Based Services — Financial Management Services (FMS)
Elective one and two vessel coronary artery bypass graft to require prior authorization
Traumatic Brain Injury waiver
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
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
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 Provider Resources & Documents

expand Behavioral Health & Screening Tools
Patient Health Questionnaire (PHQ-9)
Mood Disorder Questionnaire
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
2017 Preventive Health Guidelines
expand Disease Management Centralized Care Unit
How to Use DMCCU
expand Emergency Transportation Billing
Emergency Transportation Billing
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EPSDT Reminder Program
EPSDT Toolkit Quick Reference Guide
expand Find Your Provider Representative
Behavioral Health Provider Territory Map
expand Forms
State Forms (consent, sterilization, etc.)
Precertification Request Form
Blood Lead Testing for High-risk Children
Medical Necessity Appeal Form
BH Concurrent Review Fax Form - Medicaid
Recoupment Notification Form
State Eligibility Tracking Form
PCP Change Request Form (Spanish)
Autism Waiver Outpatient Treatment Request Form
Behavioral Health Discharge Note
Neuropsychological Testing Request Form
PRTF Prior Authorization Request Form
expand HPV Education
You Are the Key to HPV Cancer Prevention
Human Papillomavirus (HPV)
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expand Known Issues Log
expand Manuals & Referral Directories
Kansas Provider Manual
Scion Dental Provider Manual
Billing Guide
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Program Overview
Prenatal Ultrasound Policy
Healthy Rewards Flier
Coding Spotlight — Pregnancy
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters - Archived
Provider News Issue 1 2013
Provider News Issue 2 2015​
Provider News Issue 4 2015
Provider News Issue 2 2016
Provider News Issue 4 2016
2017 Quarter 2 Provider Newsletter
2017 December Provider Newsletter
expand Newsletters - Current
April 2018 Provider Newsletter
August 2018 Provider Newsletter
expand Pharmacy
Kansas Formulary
Medication Therapy Management Pharmacy Locator
Medical Injectables Prior Authorization
Synagis Enrollment Form
Synagis® PA Process Overview
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Quality improvement summary​
HEDIS Overview
HEDIS Well Child Visits Weight Assessment
HEDIS Behavioral Health
HEDIS Benchmark
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Reimbursement Policies
expand Training Programs
Pharmacy Provider Education Presentation
Cultural Competency Toolkit
Moving Toward Equity in Asthma Care CME
2018 Nursing Home and ICF Provider Orientation Schedule
2018 Availity Overview Schedule
2018 Behavioral Health Provider Overview Schedule
2018 Provider Orientation Invite Schedule
My Diverse Patients Training: Creating an LGBT-Friendly Practice
My Diverse Patients
expand Tutorials
Medication Precertification Tutorial
Precertification Status and Appeals Tutorial
Member Information and Panel Listing
How to Submit a Corrected Claim on Availity
How to Submit Appeals on Availity
Reconsideration, Appeal, and State Hearing Flier
Nursing Facility Provider Overview
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
NCQA MHC Distinction Seal

Kansas State Communications

Effective April 2017, the Kansas Department of Health and Environment, Division of Health Care Finance (KDHE-DHCF) in conjunction with the fiscal agent and KanCare managed care organizations (MCOs) is publishing one bulletin to providers for information related to all KanCare policies and issues. Amerigroup Kansas, Inc. is providing these consolidated publications here in the Kansas State Communications section of our website. Information and updates related solely to Amerigroup are located in the News & Announcements section above.



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