Louisiana | Providers – Amerigroup

Medicaid expansion will go into effect on July 1, 2016

Effective July 1, 2016, Healthy Louisiana, formerly Bayou Health, will expand to include a new population. Medicaid expansion, under the Affordable Care Act (ACA), primarily benefits working people who would otherwise be uninsured. Approximately 300,000 to 450,000 additional Louisiana residents could qualify for Healthy Louisiana. Learn more

News & Announcements

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Retroactive member enrollment claims processing
Inpatient hospital claims that initiate with an outpatient status
Retraction notice: recoupment for revenue codes billed with inappropriate procedure codes
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Mumps Alert Provider Update
Healthy Louisiana Electronic Health Records Incentive Program
Incorrect claims denials for CPT code 77063
URGENT: Healthy Louisiana schedules flood-related emergency response calls for providers
URGENT: Flood Message Update
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Pharmacy and Therapeutics Committee Meeting December 8, 2016
Pharmacy and Therapeutics Committee Meeting Minutes - August 29, 2016
Elective one and two vessel coronary artery bypass graft to require prior authorization
Quarterly pharmacy formulary change notice effective November 1, 2016
Medically unnecessary Cesarean sections
2016 Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
Pediatric Day Health Care Program Policy Changes
Notification of Pregnancy Form Update
Pharmacy and Therapeutics Committee Meeting August 26, 2016
Transition to 15-minute Units for Home Health Aid Services
Gold Ticket to Health
Federal nondiscrimination and accessibility update
Precertification update for vascular embolization or occlusion services
New Benefits for Medicaid Expansion
POS Code Billing Requirements for PDHC Facilities
Zika virus guidance for providers caring for pregnant women and women of reproductive age
Update: Certain drugs to require prior authorization
Vital Decisions Living Well Program
Quarterly pharmacy formulary change notice effective July 1, 2016
Pharmacy and Therapeutics Committee Meeting Minutes - May 10, 2016
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Hurricane Season Preparedness
DHH LARC Bulletin & Guide
Emergency medical transportation and nonemergency ambulance transportation requirements
Healthy Louisiana Medicaid Expansion
PCP Reassignment Requests
Precertification Lookup Tool (PLUTO) updates
Precertification for knee and spine orthoses effective July 1, 2016
Attention: Nonemergency ambulance transportation claim providers
Update on Pharmacy Prior Authorization Submissions
Response to March 2016 flooding and affected Amerigroup Louisiana, Inc. members residing in declared disaster parishes
Pharmacy and Therapeutics Committee Meeting Minutes - February 24, 2016
Quarterly Pharmacy Formulary Change Notice effective May 1, 2016
Pharmacy benefits for some Amerigroup Louisiana, Inc. members receiving behavioral health services
Updated DHH Bulletin IB16-2 - Claims Processing Edits for Provider Taxonomy
Resubmission Instructions for Voided Emergency Ambulance Claims
DHH Notice to All Providers Managing Updates to Enrollees' TPL Files
Requirement for Attention Deficit Hyperactivity Disorder (ADHD) medication follow-up visits
Durable medical equipment
Recoupment for revenue codes billed with inappropriate procedure codes
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
OrthoNet Claims Denials
Precertification for knee arthroscopy effective April 1, 2016
Precertification for knee and hip arthroplasty effective May 1, 2016
Intensity modulated radiation therapy (IMRT) codes that now require prior authorization
Prior authorization for nonemergency ambulance transportation for nursing home residents
Authorization waiver for echocardiography
Pharmacy and Therapeutics Committee Meeting Minutes - December 9, 2015
ICD-10-CM official guidelines for coding and reporting: Use of Z codes for delivery encounters
Quarterly pharmacy formulary change notice
Quarterly Formulary Change Notice Effective December 1, 2015
New void reason code on claims and encounters for retro disenrolled members
Allergy Immunotherapy Guidelines Update
Southeastrans Provider Update
Pharmacy and Therapeutics Committee Meeting Minutes
Hemophilia drugs medical necessity reviews
Scoliosis and spinal deformity medical necessity reviews
Q2 MPTAC Notification
Adolescent well-care visits for children 12 – 21 years old
Prior authorization required for drugs Entyvio and Cyramza
17P Rate Change Information
Formulary Change Notice Effective October 1, 2015
Cervical Length Screening Guidelines
Covering Provider Information
On Hold: Member-PCP Alignment
Home Health Therapy Codes Update Effective September 1, 2015
Important Notice for Amerigroup Providers Regarding Durable Medical Equipment and Medical Supply Services
Postpartum Checkups
Notification of Changes to Timely Filing
Now available: Send Claims Medical Attachments through Availity
Spine surgery program FAQ
ICD-10 Coded Prior Authorizations Accepted Effective June 1
Reimbursement for early periodic screening diagnosis and treatment (EPSDT)
CPT code changes for 2015: Drug screening services
Immediate postpartum placement of long-acting reversible contraception
Primary care provider (PCP) automatic assignment process for members
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
OrthoNet medical necessity reviews
IUDs, prenatal vitamins, circumcision, and Maternal Quality Improvement​
Prenatal ultrasound coverage and coding​
39 week initiative​
Personal care services
Pharmacy Formulary Change Notice Effective April 1, 2015​
Notification of changes to Bayou Health contract
Administrative corrections for retro enrolled members
Hospice Care Services Notice
Down Syndrome Information Available on DHH Website​
Pharmacy Benefit Manager Change to Express Scripts Effective February 1, 2015
PCP Rate Decommission
Patient360 Lets You Access Member Records in a Few Clicks
Intrauterine devices (IUDs) now available at pharmacies
Precertification required for pediatric day health care services
Postponed Upcoming Disbursement Process Changes
Upcoming changes to durable medical equipment precertification requirements
Denial of Noncovered Inpatient Hospital Claims
Availity Announcement and Frequently Asked Questions
CMS Emergency Preparedness Checklists
Electronic Claims Update
Updated CMS 1500 Form
Coming Soon! Enhanced Online Precertification Tool
Precertification Requirement Correction
New Website Password Requirements
Provider Emergency Preparedness Alert
August 1 Changes to Precertification Guidelines
Medication Precertification Tool Available Now
The New Electronic Health Risk Assessment Form
Block Vision Provider Alert
Modifier - 25 Edits Deactivated
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
Changes to Your Amerigroup Louisiana Provider Handbook
Updated Clinical Practice Guidelines Now Available
EPSDT Toolkit is here!
Preventing the Flu
May 1, 2013, Change to UniCare CPBs & Guidelines
Our Medicaid ID Cards Have Gone Mobile!
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Provider Self-Service

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NCQA New Health Plan Accreditation

 Provider Resources & Documents

expand Behavioral Health
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 1
Provider Bulletin 2014, Issue 3
Notification of changes to Bayou Health contract
Provider Bulletin 2015, Issue 1
expand Clinical Practice Guidelines
Clinical Practice Guidelines Matrix
expand Disease Management Centralized Care Unit
About DMCCU
expand EPSDT Resources
EPSDT Reminder Program
EPSDT Provider Training
CDC BMI Percentile Chart - Girls
expand Forms
Precertification Request Form
DHH HPA 15/7 TPL Form
Therapy Prior Authorization Request Form ​
Attestation Amendment Form
Practitioner Clinical Medical Record Review Form
Authorization to Release or Obtain Health Information
Louisiana Roster Template
Behavioral Health Outpatient Treatment Form
expand Frequently Asked Questions
expand Handbooks & QRCs
Provider Quick Reference Card
expand ICD-10
ICD-10
expand Maternal Child Program
Prenatal Ultrasound Policy
17P Provider Letter
Notification of Pregnancy Form
expand Member Eligibility
Member Eligibility: What to Know and Do
expand Newsletters
Provider News Issue 2 - 2013
Provider News Issue 4 - 2013
Provider News Issue 4 2014
Provider News Issue 2 2015
Provider News Issue 1 2016
Provider News Issue 3 2016
expand Pharmacy
Pharmacy Tools
Searchable Formulary
Pharmacy Prior Authorization Form
Natn'l Drug Code FAQs
Common OTC Medications List
Bayou Health Common PDL
expand Quality Management
HEDIS 2016 Reference Guide
expand Quick Tools
Reimbursement Policies
expand Referral Directories
Louisiana Referral Directory
Pharmacy Directory
expand State Communications
Prevention of Unintended Pregnancy and Risks Associated With Zika
IPAT Survey Reminder Letter
Provider Issue Escalation and Resolution
expand Training Programs
New Provider Orientation Webinars Invite
Cultural Competency Training
Cultural Competency Training Invite
expand Tutorials
Precertification Status and Appeals Tutorial
Provider Updates: Account Information
Member Information and Panel Listing
expand Vendor/Partner Links & Information
Quest Diagnostics, Inc. (Laboratory Services)
BAYOU HEALTH Informational Bulletin
AIM (Diagnostic and Imaging Service Authorizations)
Superior Vision (formerly Block Vision)
Service Partners Card
Louisiana

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