Maryland | Providers – Amerigroup

News & Announcements

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
Long-acting reversible contraception
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
Adding modifier 52 to the routine anatomic evaluation billing code
OP Procedure Precert Update Notification
Genetic testing services to require prior authorization
Additional information on ClaimCheck® upgrade to ClaimsXten™
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
Medline — new national vendor for incontinence management
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
Incontinence Supplies Benefit Limit
How to bill Amerigroup Community Care for vaccines
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
Case Management Programs and Care Coordination flier
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
Block Vision codes for routine vision benefit
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
Clarification: Somatic Care Physician Payment Responsibility for Basic Drug Screening Lab Test
ICD-10 Coded Prior Authorizations Accepted Effective June 1
Focused claim review program questions and answers
Advair Formulary Change Notice Effective July 1, 2015
Update: OrthoNet to conduct professional service coding reviews for musculoskeletal providers
Low tech radiology and site of service redirection
Claims recoupment
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
Maryland’s #AmerigroupChallenge frequently asked questions
Important message for substance use disorder providers
Substance abuse benefit carve-out
ER auto pay list update​
Hospital Notification of Claims Edits
Reminder: New Outpatient Imaging Partner Effective Nov. 1
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.
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
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
Medicare Requirements for Outpatient Therapy Claims
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
Physician Assistant Billing Changes
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
Prepayment Reviews for Amerivantage Inpatient Readmission Claims
Our Preferred Lab Vendors
Important Notice: Medicare Advantage Sequestration
Reimbursement for Administrative Hospital Days
Updated Clinical Practice Guidelines Now Available
Earn Rewards and Recognition for Building a Culturally Competent Practice
Medicare No Longer Available in Baltimore City Effective January 1, 2013
decrease font size default font size increase font size

Provider Self-Service


Provider Survey

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

NCQA HP Accreditation Seal
NCQA MHC Distinction Seal

 Provider Resources & Documents

expand Behavioral Health
Behavioral Health Case Management Flier
expand Claims Submission and Reimbursement Policy
Reimbursement for Hospital Administrative Days
Provider Bulletin 2014, Issue 2
Hospital observation policy changes
Provider Bulletin 2015, Issue 1
Updated Maryland ER Auto Pay List
expand Clinical Practice Guidelines
Clinical Practice Guidelines Matrix
expand Disease Management Centralized Care Unit
Contacting DMCCU
Disease Management Referral Form
expand EPSDT
EPSDT Provider Training
Amerigroup Community Care Rewards Raffle program
expand Forms
Blood Lead Testing for High-risk Children
Personalized Treatment Plan
Well-care Assessment Form - Adolescent
CMS-1500 Form
UB-04 Claim Form
Transition of Care Post Hospital Follow-up Checklist
BH Initial Review Fax Form - Medicaid
Practice Profile Update Form
Recoupment Notification Form
Case Management Provider Referral Form
Provider office assessment tool
NovaSom Home Sleep Test (HST) Order Form
expand ICD-10
expand Manuals & QRCs
HealthChoice Provider Manual
Inpatient Admission, Concurrent and Retrospective Review Quick Reference Card
expand Maternal Child Program
TCOBAM Program Flier
Prenatal Ultrasound Policy/ICD-10 Update
Zika Virus Information Packet
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 4 2014
Provider News Issue 2 2015​
Provider News Issue 4 2015
Provider News Issue 2 2016
Provider News Issue 4 2016
expand Newsletters - Current
2017 Quarter 2 Provider Newsletter
expand Pharmacy
Pharmacy Tools
Medicaid Preferred Drug List
Natn'l Drug Code FAQs
Synagis Enrollment Form
State Hepatitis C Sample Treatment Plan​
Substance Abuse Medication Carve-Out Notice​
State Hepatitis C Enhanced Treatment Plan
Prior Authorization Form
State Opioid Prescribing Guidance and Policy (Resource)
Common OTC Medications List
Analgesic Opioid Quantity Limits
expand Quality Management
HEDIS Provider Resource Catalog
Medicaid QM Desktop Reference Guide
Colorectal Cancer Education 80% by 2018 Fact Sheet
Shared Goal: Reaching 80% Screened for Colorectal Cancer by 2018
expand Quick Tools
Precertification Lookup Tool
Medical Policies
expand Referral Directories
expand Training Programs
Cultural Competency Training
Moving Toward Equity in Asthma
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)
Maryland Department of Social Services
The Coordinating Center
AIM (Diagnostic and Imaging Service Authorizations)
Express Scripts Prior Authorization

Do more online through Provider Self-Service!

  • File and check the status of medical claims
  • Verify eligibility
  • Request precertification
  • 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 to register today.

Visit Frequently Asked Questions about Availity for more information.