Maryland | Providers – Amerigroup
 

COVID-19 News and Resources

Medicaid Provider Partnership Required to Support COVID-19 Testing Goals (July 6, 2020)
COVID-19 testing
HHS announces additional distributions from the Provider Relief Fund to eligible Medicaid and CHIP providers (6/15/2020)
Amerigroup Community Care suspends select prior authorization rules and announces significant policy adjustments in response to unprecedented demands on health care providers (updated May 30, 2020)
COVID-19 information from Amerigroup Community Care (June 4, 2020)
Listen now! Webinar recording available from Amerigroup Community Care for network providers on SBA loans and other federal relief programs in response to COVID-19
Ordering COVID-19 Labs
Information for Providers on COVID-19 Testing Availability in Baltimore City
COVID-19 information from Amerigroup Community Care (April 22, 2020)
Federal resources available for health care providers and employers in the federal CARES Act
Revised Charging and Reporting for Expanded Telehealth Services
Preserving the Supply of Necessary Drugs
COVID-19 Provider Enrollment
Processing Prior Authorizations, Provider and Enrollee Communications, and Telehealth Place of Service Codes
Temporary Registration of Registered Behavior Technicians and Telehealth Guidance for ABA Providers
Temporary Non-Enforcement of Medical Assistance Pharmacy Preauthorization Requirements
Follow-up Guidance on Telephone Telehealth Services and Expansion of Medicaid Telehealth Regulations
Maryland Department of Health Alert Concerning Prescriptions Related to COVID-19
Maryland Department of Health Temporary Waiver of Requirements for Concurrent Review Process for Acute Care Hospitals
Maryland Department of Health Signatureless Deliveries of Pharmaceuticals
Maryland Department of Health Telehealth Dentistry Guidance
Maryland Department of Health Temporary Waiver of Premium Payments for EID and MCHP Premium
Maryland Department of Health Temporary Waiver of Requirements for PASRR and MDS Validations
Maryland Department of Health Temporary Expansion of Remote Patient Monitoring Services
Maryland Department of Health Updated Medicaid Telehealth Program Guidance
Maryland Department of Health COVID-19 Information and Updates
Maryland Department of Health COMAR 10.01.04 Extension of Medicaid Appeals
Maryland Department of Health NEMT Memo
Maryland Department of Health NEMT Guidance
COVID-19 #7: Disposable Medical Supplies (DMS) and Durable Medical Equipment (DME)
COVID-19 #3a: Non-Emergency Medical Transportation (NEMT)
Resources to support our community during the COVID-19 pandemic
COVID-19 #4a: Temporary Authorization of Audio-Only Health Care Services to Mitigate Possible Spread of Novel Coronavirus ("COVID-19') Executive Order No. 20-03-20-01 (March 21, 2020)
COVID-19 #4b: Temporary Authorization of Audio-Only Health Care Services to Mitigate Possible Spread of Novel Coronavirus ("COVID-19') Executive Order No. 20-03-20-01 (March 21, 2020)
COVID-19 #4c: Temporary Authorization of Audio-Only Health Care Services to Mitigate Possible Spread of Novel Coronavirus ("COVID-19') Executive Order No. 20-03-20-01 (March 21, 2020)
Declaration of State of Emergency and Existence of Catastrophic Health Emergency - COVID-19 (March 20, 2020)
Maryland Insurance Administration Bulletin 20-05 COVID-19 (March 20, 2020)
Temporary Expansion of Medicaid Regulations to Permit Delivery of Telehealth Services to the Home to Mitigate Possible Spread of Coronavirus "COVID-19" (March 20, 2020)

News & Announcements

Prior authorization requirements for 0200T and 0201T
May 2020 Medical Policies and Clinical Utilization Management Guidelines update
October 2020 HEDIS lead results tip
Quarterly pharmacy formulary change notice effective August 1, 2020
Clinical Criteria Web Posting May 2020
Transition to AIM Specialty Health Rehabilitative Services Clinical Appropriateness Guidelines
New MCG Care Guidelines 24th edition Viral Illness
Provider demographics update
Provider Coding Education (CME/CEU) Invitation
Clinical Criteria Web Posting March 2020
90-day supply for asthma controllers
Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
February 2020 Medical Policies and Clinical Utilization Management Guidelines update
InterQual 2020 update
Modifier use reminders
Quarterly pharmacy formulary change notice effective May 1, 2020
Clinical Criteria Web Posting February 2020
2020 affirmative statement concerning utilization management decisions
MCG care guidelines — 24th edition
Electronic submission is preferred method for requesting pharmacy prior authorization
New provider contracting system
Prior authorization requirements: new 2020 codes for coverage and precertification
November 2019 Medical Policies and Clinical Utilization Management Guidelines Update
HEDIS general announcement
Incorrect Claims Payments Alert
Clinical Criteria Web Posting December 2019
Clinical Criteria Web Posting November 2019
Prior authorization requirements for Q5103
Availity - Provider FAQ
Availity Provider Notification
J code redirection
Remicade infusion precertification initiative
New specialty pharmacy medical step therapy ESA/CSF requirements - Effective March 1, 2020
Revision to evaluation and management services — over-coded services postponed
Quarterly pharmacy formulary change notice effective February 1, 2020
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update
InterQual 2019.1 update
Multiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update
2019 Provider Satisfaction (PSAT) and CAHPS survey results
Improving the Patient Experience – CME
Modifier 26 and TC: Professional and Technical Component Policy Update
Clinical Criteria Web Posting September 2019
August 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Clinical Criteria Web Posting August 2019
Medicaid Enrollment Reminder
Outpatient Orthopedic Precertification Initiative effective October 1, 2019
Quarterly pharmacy formulary change notice effective November 1, 2019
Clinical Laboratory Improvement Amendments
March 2019 Clinical Utilization Management Guidelines
Prior Auth Changes CCRT Configuration
March 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Clinical Criteria Web Posting July 2019
June 2019 Medical Policies and Clinical Utilization Management Guidelines Update
InterQual 2019 update
Semi-Annual Cost of Care Review
Customization for IP Cancer Therapy
Review of information on file for your practice
Audiology codes requiring precertification
Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy
Clinical Criteria Web Posting Q1 2019
Quarterly pharmacy formulary change notice effective August 1, 2019
Beacon Health Options
Clinical Criteria Web Posting Q2 2019
January 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Unspecified DX Code Update
Updating your provider data
How to Contact IngenioRx Specialty Pharmacy Beginning May 1, 2019
2019 Utilization Management Affirmative Statement concerning utilization management decisions
Quarterly pharmacy formulary change notice part II effective May 1, 2019
New Specialty Pharmacy Medical Step Therapy Requirements
Outpatient general surgery precertification initiative
Updating Your Provider Data
Quarterly pharmacy formulary change notice effective May 1, 2019
Pharmacy benefit manager change to IngenioRx
November 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Clinical Criteria updates
September 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Medical necessity review for appropriate level of care
Quality Improvement Program
Quarterly pharmacy formulary change notice effective February 1, 2019
Physical and occupational therapy reviews
July 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Remind your patients about renewal dates
Electronic data interchange gateway update
Prior authorization requirements for Subcutaneous Implantable Defibrillator system
Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
Prenatal formulary change notice effective August 1, 2018
Medical Necessity Criteria Changes
Quarterly pharmacy formulary change notice effective October 1, 2018
Amerigroup cordially invites you and your staff to an Availity Claims Payment Disputes training webinar
Prior authorization requirements for high-level, definitive drug testing
Prior authorization requirements for Interferon beta-1a
Prior authorization requirements for Somatrem
May 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Wound care treatment request update
Billing guidelines for developmental and mental health screening and assessment in primary care
Medical Policies and Clinical Utilization Management Guidelines update - March 2018
Medical Policies and Clinical Utilization Management Guidelines update - January 2018
Quarterly pharmacy formulary change notice effective August 1, 2018
Long-Acting Reversible Contraception Update: Effective February 1, 2018
Prior authorization requirements for Cabazitaxel
TYSABRI infusion prior authorization initiative
Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)
Zepatier, cough and cold pharmacy formulary change notice effective June 1, 2018
Obstetric imaging precertification
Colon cancer screening vendor
ICS pharmacy formulary change notice update: effective April 15
Services requiring prior authorization
Prior authorization requirements for Darzalex drug
Electrical stimulation device to require prior authorization
Provider Satisfaction Survey
Quarterly pharmacy formulary change notice effective May 1, 2018
Prior authorization requirement update for Mylotarg
Q4 Medical Policies and Clinical Utilization Management Guidelines Updates
EPSDT General Announcement
Long-Acting Reversible Contraception Reminder
ICS Pharmacy Formulary Change Notice
Medical Policy update - Hyaluronan Injections
Eight injectable drugs will require prior authorization
AIM Musculoskeletal Guidelines
Elotuzumab to require prior authorization
Q3 Medical Policies and Clinical Utilization Management Guidelines Updates
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
Age limits pharmacy formulary change notice effective February 1, 2018
2017 Provider Satisfaction Survey Report
Morpace Directory Validation Fax Blast
Effective January 1, 2018, providers will be required to use ProView for credentialing
Quarterly pharmacy formulary change notice effective February 1, 2018
Effective January 1, 2018: new pharmacy prior authorization fax number
New Pharmacy Electronic Prior Authorization (ePA) Request Tool
Lower Leg Stents To Require Prior Authorization
New review process for not otherwise classified drug codes
Mavyret pharmacy formulary change notice effective November 1, 2017
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Genetic testing services prior authorization update
Quarterly pharmacy formulary change notice effective November 1, 2017
New case management program for PTSD in the neonatal intensive care unit
Q2 Medical Policies and Clinical Utilization Management Guidelines update
SA Opioid QL Formulary Change Notice
Hemophilia factor injections to require prior authorization
Quarterly pharmacy formulary change notice effective July 1, 2017
Quarterly pharmacy formulary change notice effective August 1, 2017
Diabetic Education Precertification Change
Wheelchair component or accessory, not otherwise specified to require prior authorization
Outpatient ophthalmology precertification initiative
Q1 Medical Policies and Clinical Utilization Management Guidelines update
Quarterly pharmacy formulary change notice effective July 1, 2017
Quarterly pharmacy formulary change notice effective May 1, 2017
OP Procedure Precert Update Notification
Genetic testing services to require prior authorization
Adding modifier 52 to the routine anatomic evaluation billing code
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Quarterly pharmacy formulary change notice effective March 1, 2017
Continuous interstitial glucose monitoring to require prior authorization
Quarterly pharmacy formulary change notice effective Febrary 1, 2017
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
NovaSom is the preferred sleep study vendor
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Elective one and two vessel coronary artery bypass graft to require prior authorization
Quarterly pharmacy formulary change notice effective November 1, 2016
Sterilization Consent Form submission
QVAR pharmacy formulary change notice effective September 1, 2016
Q2 Medical policies and Clinical Utilization Management (UM) Guidelines (9/28/16)
Quarterly pharmacy formulary change notice effective September 1, 2016
Changes to after-hours incentive rates
Quarterly pharmacy formulary change notice effective October 1, 2016
New online processes for electronic remittance advices and electronic funds transfers
Introducing the new remittance viewer!
Radiation oncology prior authorization to be managed by AIM®
Federal nondiscrimination and accessibility update
Update: Certain drugs to require prior authorization
Precertification update for vascular embolization or occlusion services
Quarterly pharmacy formulary change notice effective July 1, 2016
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Access and Availability Requirements
Precertification for knee and spine orthoses effective July 1, 2016
Update on Pharmacy Prior Authorization Submissions
Cystic Fibrosis testing benefit limit update
Medical policies update
Quarterly pharmacy formulary change notice
Back Brace Precertification
Upcoming Prior Authorization Changes
Precertification for knee and hip arthroplasty effective May 1, 2016
Precertification for knee arthroscopy effective April 1, 2016
Pharmacy education – step therapy, quantity limits
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Quarterly pharmacy formulary change notice
NCQA Provider Grievances Guide
Quarterly Formulary Change Notice Effective December 1, 2015
Scoliosis and spinal deformity medical necessity reviews
Hemophilia drugs authorization changes effective November 15, 2015
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Prior authorization required for drugs Entyvio and Cyramza
Cervical Length Screening Guidelines
Physician assistants in the Medicaid HealthChoice Program
Home Health Therapy Codes Update Effective September 1, 2015
Now available: Send Claims Medical Attachments through Availity
Procedures in ambulatory surgery centers
ICD-10 Coded Prior Authorizations Accepted Effective June 1
Advair Formulary Change Notice Effective July 1, 2015
Credentialing of provider applications - On February 23, 2015, the Council for Affordable Quality Healthcare (CAQH) launched proview. Since that time, there have been systems issues affecting access and retrieval of provider applications.
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
Pharmacy Formulary Change Notice Effective April 1, 2015
Medicaid PCP Rate Increase
2014 Quality Improvement Program Survey Results
Important message for substance use disorder providers
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
OrthoNet Physical and Occupational Therapy Reviews
Flu Vaccinations
Medicare Advantage Peer to Peer Changes
Inpatient Readmissions
Encourage Exercise to Prevent Falls
October 2014 Formulary Change Notice
Patient360 Lets You Access Member Records in a Few Clicks
Upcoming changes to durable medical equipment precertification requirements
Postponed Upcoming Disbursement Process Changes
Quarterly Pharmacy Formulary Change Notice
Hepatitis C Medication Coverage for Amerigroup Maryland, Inc.
Register Now for Availity
Pharmacy First-Fill 15-Day Supply Program
Prenatal Risk Assessment
A New Sleep Study Management Program for In-Home Sleep Testing (HST)
Availity Announcement and Frequently Asked Questions
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Coming Soon! Enhanced Online Precertification Tool
Updated CMS 1500 Form
Quarterly Pharmacy Formulary Change Notice
Medicare Advantage Product Highlights Provider Letter
Quarterly Pharmacy Formulary Change Notice
New Website Password Requirements
August 1 Changes to Precertification Guidelines
The New Electronic Health Risk Assessment Form
Pharmacy Precertification Tool Available Now
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
The Medicare Health Outcomes Survey
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
Our Preferred Lab Vendors
Reimbursement for Administrative Hospital Days
Updated Clinical Practice Guidelines Now Available
Earn Rewards and Recognition for Building a Culturally Competent Practice
decrease font size default font size increase font size

Provider Self-Service

md-state-styles.css
provider-survey.css

Provider Survey

Please help us improve our provider website by taking this brief survey
Take Survey

Amerigroup MD Value Added Benefits

Important Numbers to Know

NCQA Health Plan Accreditation evaluates the quality of health care health plans provide to their members.

NCQA HP Accreditation Seal

Commendable

NCQA MHC Distinction Seal

Multicultural
Health Care
Distinction

 Provider Resources & Documents

expand Behavioral Health
Beacon Health Options: Brand Implementation
BH Outpatient Treatment Report Form
Request for Authorization - Neuropsychological Testing Form
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 2
Observation Policy
Electronic Data Interchange (EDI)
CMS and State Identified Non-covered Codes
Charge Audit Policy
Blood Lead Test Reimbursement
Coordination of Benefits Explanation of Benefits Copayment Request Form
Request for Appeal
Reimbursement Policy Disclaimer
expand Clinical Practice Guidelines
Outpatient general surgery precertification initiative
Preventative Health Guidelines
expand Disease Management
Contacting Disease Management
Disease Management Referral Form
expand EPSDT
EPSDT Provider Training
expand Forms
Blood Lead Testing for High-risk Children
Personalized Treatment Plan
Well-care Assessment Form - Adolescent
CMS-1500 Form
PCP Change Request Form
Physical Therapy/Occupational Therapy Fax Request Form
Psychological Testing Request Form
Overpayment Refund Notification Form
Precertification Request Form
Coordination of Care and Treatment Summary
NovaSom Home Sleep Test (HST) Order Form
Group Setup Form Update
Claim Correspondence Form (Medicaid and Medicare)
Precertification Code List
Counsel for HIV Antibody Blood Test - English
Consent to Sterilization Physicians Statement
Clinical Medical Record Audit
Patient Drug Profile
Specialist as PCP Request
Provider Demographic Update Form
Request for Authorization - Psychological Testing
expand Manuals & QRCs
Maryland Medicaid QRC
Medicaid QM Desktop Reference Guide
expand Maternal Child Program
Prenatal Ultrasound Policy/ICD-10 Update
Zika Virus Information Packet
Makena Prior Authorization Form
Post Partum Checkups
Maternity Notification Form
expand Medical Management Model
Health Education and Wellness
expand Newsletters - Archived
Provider News Issue 2 2012
Provider News Issue 4 2012
Provider News Issue 2 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
April 2018 Provider Newsletter
August 2018 Provider Newsletter
December 2018 Provider Newsletter
April 2019 Provider Newsletter
August 2019 Provider Newsletter
expand Newsletters - Current
December 2019 Provider Newsletter
April 2020 Provider Newsletter
August 2020 Provider Newsletter
expand Pharmacy
Medicare Formulary
Medicaid Formulary
State Hepatitis C Therapy Prior-Authorization Form
State Hepatitis C Clinical Criteria​
State Hepatitis C Retreatment Form​
State Hepatitis C Enhanced Treatment Plan
Prior Authorization Form
State Opioid Prescribing Guidance and Policy (Resource)
Common OTC Medications List
Analgesic Opioid Quantity Limits
Hot Tips
expand Quality Management
Health Promotions Support Services
Colorectal Cancer Education 80% by 2018 Fact Sheet
Shared Goal: Reaching 80% Screened for Colorectal Cancer by 2018
HEDIS Benchmarks and Coding Guidelines for Quality Care
expand Quick Tools
Reimbursement Policies
Audiology Clinical Coverage Criteria
expand Referral Directories
Provider Directory – Baltimore City
Provider Directory – Eastern Shore
Provider Directory – Southern MD
Specialty Reference Guide - Anne Arundel County
Specialty Reference Guide - Eastern Shore
Specialty Reference Guide - Howard County
Specialty Reference Guide - Prince Georges County
Specialty Reference Guide - Cecil County
expand Training Programs
Cultural competency and patient engagement
My Diverse Patients Training: Breast Cancer Screening for African American Women
My Diverse Patients Training: Reducing Health Care Stereotype Threat
Caring for Diverse Populations Toolkit
Improving the Patient Experience CME
expand Tutorials
Precertification Status and Appeals Tutorial
Member Information and Panel Listing
expand Vendor/Partner Links & Information
LabCorp (Laboratory Services)
Transportation Services Letter Provider List
ImmuNet: Maryland’s Immunization Registry
Medtox
AIM (Diagnostic and Imaging Service Authorizations)
CoverMyMeds electronic Prior Authorization (ePA)
Maryland

Do more online through Provider Self-Service!

  • File and check the status of medical claims
  • NEW — Submit Claims Payment Disputes electronically via Availity
  • Verify eligibility
  • Request precertification via the Interactive Care Reviewer (ICR)
  • Conduct an inquiry on the status of any precertification request via ICR
  • For more information on ICR such as features, support or training go to
    ICR-Help
  • Submit a Pharmacy Prior Authorization Request
  • And much more!

To log in, use your Availity ID and password. If you need an Availity ID, visit www.Availity.com to register today.

Visit Frequently Asked Questions about Availity for more information.

For Vision & Dental

If you are requesting one of the services listed below, do not continue with your request through the Availity portal:

Routine Vision Services
Please contact Block Vision at 1-800-243-1401.

Dental Services
Adult non-pregnant members, please contact DentaQuest at 1-800-720-5949.

Children and pregnant members, please contact Maryland Healthy Smiles Dental Program at 1-888-696-9596.