Maryland | Providers – Amerigroup
 

News & Announcements

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
2018 Utilization Management Affirmative Statement
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
Remicade infusion precertification initiative
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
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
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 Provider Resources & Documents

expand Behavioral Health
Beacon Health Options: Brand Implementation
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 2
Observation Policy
Electronic Data Interchange (EDI)
CMS and State Identified Non-covered Codes
expand Clinical Practice Guidelines
Outpatient general surgery precertification initiative
2018 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
BH Concurrent Review Fax Form - Medicaid
Psychological Testing Request Form
Overpayment Refund Notification Form
Precertification Request Form
PCP Change Request Form (Spanish)
expand ICD-10
ICD-10
expand Manuals & QRCs
Maryland Medicaid QRC
expand Maternal Child Program
Maternity Notification Form
Prenatal Ultrasound Policy/ICD-10 Update
Zika Virus Information Packet
Makena Prior Authorization Form
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters - Archived
Provider News Issue 3 2012
Provider News Issue 1 2013
Provider News Issue 1 2015
Provider News Issue 3 2015
Provider News Issue 1 2016
Provider News Issue 3 2016
2017 Quarter 1 Provider Newsletter
2017 Quarter 3 Provider Newsletter
February 2018 Provider Newsletter
June 2018 Provider Newsletter
October 2018 Provider Newsletter
expand Newsletters - Current
February 2019 Provider Newsletter
June 2019 Provider Newsletter
October 2019 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 – Central MD
Provider Directory – Montgomery, Prince George & DC
Provider Directory – Western MD
Specialty Reference Guide - Baltimore County
Specialty Reference Guide - Frederick County
Specialty Reference Guide - Montgomery County
Specialty Reference Guide - Harford County
expand Training Programs
Moving Toward Equity in Asthma Care CME
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
Provider Updates: Account Information
Medication Precertification Tutorial
expand Vendor/Partner Links & Information
Quest Diagnostics, Inc. (Laboratory Services)
DentaQuest
Maryland Department of Social Services
The Coordinating Center
Superior Vision
IngenioRx Home Delivery Form
Maryland

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