New Jersey | Providers – Amerigroup

News & Announcements

Medicare Advantage - Modifier FX and Reimbursement Policy Update
Medicare Advantage - Submitting Corrected Claims
Medicare Advantage - Bill CLIA Certification for Claims
Medicare Advantage - HCPC Codes Allow for Payment for Coordinating Behavioral Health Services
Medicare Advantage - MRP Billing Codes for Reimbursement
Wheelchair component or accessory, not otherwise specified to require prior authorization
Q1 Medical Policies and Clinical Utilization Management Guidelines update
Clinical Practice Guidelines
Medicare Advantage - Prior authorization requirement change for part B drug: Bavencio
Medicare Advantage - Prior authorization requirement change for part B drug: Herceptin
Medicare Advantage - Prior authorization requirement change for part B drug: Spinraza
Medicare Advantage - Inpatient Readmissions
Medicare Advantage - Amerivantage ESRD (HMO-POS SNP) offers benefits designed for ESRD patients
Medicare Advantage - Prior Authorization requirements for Continuous Interstitial Glucose Monitoring
Medicare Advantage - AccordantCare™ to provide support for members with HIV
Medicare Advantage - New Coding Guidelines for 3D Mammography
Medicare Advantage - Coding Patient Services Reminders
Medicare Advantage - Comply with Clinical Information Requests
Medicare Advantage - New G Codes for Home Health Agencies
Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
Medicare Advantage - New Place of Service Code 02 for Telehealth Services
Medicare Advantage - Preventive Service Procedure Codes updated for 2017
Medicare Advantage - Review High-Risk Medication Reports
Medicare Advantage - Prior Authorization Requirements for Part B Drug - Exondys 51
Medicare Advantage - Prior Authorization Requirements for Part B Drug - Evomela
Medicare Advantage - Providers Must Enroll with Medicare to be able to Prescribe Part D Beginning January 1, 2019
Quarterly pharmacy formulary change notice effective May 1, 2017
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage - CMS Emergency Preparedness Rule
Medicare Advantage - HEDIS Measure: Ensure Medication Reconciliation is Completed after Discharge
Adding modifier 52 to the routine anatomic evaluation billing code
Medicare Advantage - Radiation Therapy Services – Contact AIM for Delivery, Amerigroup for Planning
Medicare Advantage - Transitional Care Management (TCM) Services
Medicare Additional information on ClaimCheck® upgrade to ClaimsXten™
Medicare Advantage - Retrospective Medical Record Review Program Launches
Medicare Advantage - Members Should Use Hearing Care Solutions
Medicare Advantage - Claims for Tetanus Vaccinations
Medicare Advantage - Payment Reduction for X-rays Taken Using Film
Genetic testing services to require prior authorization
Additional information on ClaimCheck® upgrade to ClaimsXten™
Quarterly pharmacy formulary change notice effective March 1, 2017
Medicare Advantage - Additional Information on ClaimCheck Upgrade to ClaimsXten
Medicare Advantage - Prior Authorization Requirement Change to Epidermal Growth Factor Receptor Testing
Medicare Hospital observation service limits
Medicare Advantage - Hospitals must use Medicare Outpatient Observation Notice
Quarterly pharmacy formulary change notice effective February 1, 2017
Medicare Advantage – 2017 Annual Notice of Change
ICS pharmacy formulary change reminder - effective August 1, 2016
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Medicare Advantage – Transitional Care Management Services Eligibility
Medicare Advantage – Verify Injectable, Infusion Billable Units Approved via AIM
Medicare Advantage - Routine Physical Exams are Covered in 2017
Medicare Advantage – DSNP Provider Training
Medicare Advantage – AIM Clinical Appropriateness Guidelines for Advanced Imaging
Medicare Advantage - Attend December Webinar/Webinars to Learn how to Complete OptiNet Assessments
Medicare Advantage - Cardioverter Defibrillators : Confirm if Authorization Required for Implants
Medicare Advantage – Avoid Needless Claims Denials with These Tips
Medicare Advantage - 2017 Benefits and Formularies Available
Continuous interstitial glucose monitoring to require prior authorization
Medicare Advantage - Prior Authorization Requirements for Cuvitru, Ocrevus and Lutathera
Medicare Advantage - Prior Authorization Requirements for Intracardiac Electrophysiological Studies and Catheter Ablation
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage - Prior Authorization Requirements for Erelzi, Amjevita, Voretigene neparvovec, Nanacog and Lartruvo
Medicare Advantage - Risk Adjustment and Documentation Guidance Training Offered
Medicare Advantage - 2017 Coverage Changes for Diabetic Supplies
2016 Medicare Clinical Practice Guideline Matrix
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Medicare Advantage - Clarification for Requesting Authorization for certain Arterial Duplex Imaging Procedures
Medicare Advantage - Prior Authorization Requirements for Continuous Interstitial Glucose Monitoring
Elective one and two vessel coronary artery bypass graft to require prior authorization
Quarterly pharmacy formulary change notice effective November 1, 2016
Medicare Advantage - Amerigroup to Conduct Periodic Audits to Ensure CMS Requirements
Medicare Advantage - Use JW Modifier When Submitting Claims for Discarded Drugs
Medicare Advantage - Follow CMS Guidelines for Part B Immunizations Claims Filing
Medicare Advantage - Help Ensure Part D Members Receive a Comprehensive Medication Review
Medicare Advantage - Self-Administered Drugs cannot be Billed to Members
Medicare Advantage - Billing Requirements for TAVR and TMVR
Medicare Advantage - Amerigroup Follows CMS Guidelines for DME Customization
QVAR pharmacy formulary change notice effective September 1, 2016
Medicare Advantage - Prior authorization requirements for Doxil and Sustol
Medicare Advantage - Prior Authorization changes to Interferon gamma-1b, Mecasermin, and Azacitidine
Medicare Advantage - Prior Authorization Requirement for Torisel
Medicare Advantage – Prior Auth for Elective One and Two CABG
Medicare Advantage – Prior Auth for New Injectable/Infusible: Tecentriq
Medicare Advantage - Complete your Medicare Advantage AIM OptiNet® registration by Jan. 1, 2017
Medicare Advantage - Prior Authorization Requirements for Inflectra and Cinqair
Quarterly pharmacy formulary change notice effective September 1, 2016
2016 Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
Medicare Advantage - Prior Authorization Requirements for new Injectable/Infusible Drugs: Darzalex and Empliciti
Medicare Advantage - Prior Authorization Requirements for new Injectable/Infusible Drugs: Istodax, Ixempra, and Taltz
Medicare Advantage - Please Use Medicare Billing Guidelines when filing Preventive Services Claims
Medicare Advantage - Claim Adjustments May Change Member Cost Share
Medicare Advantage - Ensure the Accuracy of Your Information in the Provider Directory
Medicare Advantage - Home Health Billing Instructions
Medicare Advantage - Complying with Medical Record Documentation Requests
Medicare Advantage - Check Your Contract Prior to Rendering Supplemental Benefits
Medicare Advantage – In Home Visits Available for Members with Chronic and Complex Conditions
Medicare Advantage - In-Home Bone Mineral Density Testing
Medicare Advantage - Assisting Members with Rheumatoid Arthritis Who May Be Missing Important Medications
Medicare Advantage - Clinical Cumulative Morphine Equivalent Dosing Point of Sale Edit effective January 1, 2017
Medicare Advantage - Improve Member’s Medication Adherence with 90-Day Prescriptions
Medicare Advantage - Alendronate added to the $0 Copay Tier
Medicare Advantage - Complete Your Medicare Advantage AIM OptiNet Registration for X-ray, Ultrasound or High-Tech Imaging Services
Medicare Advantage - Care Program Available for Members Facing Advanced Illness
Medicare Advantage - AIM Clinical Appropriateness Guidelines for Advanced Imaging effective November 1, 2016
Federal nondiscrimination and accessibility update
Medicare Advantage - Prior Authorization for Emend (Fosaprepitant), Aloxi (Palonosetron), and Afstyla (Antihemophilic)
Update: Certain drugs to require prior authorization
Precertification update for vascular embolization or occlusion services
Medicare Advantage - Prior Authorization Requirements for Vascular Embolization or Occlusion Services
Quarterly pharmacy formulary change notice effective August 1, 2016
Meningococcal disease outbreak at Rutgers University
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
MedTox Filter Paper Lead Testing
Medicare Advantage - Dual Advantage Simple Billing Tips
Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
Medicare Advantage - Part D Drugs must be Prescribed for FDA-Supported Indications, Medicare Compendiums
Medicare Advantage - Outpatient Part B Nursing and Long-Term-Care Facilities: Contact OrthoNet for OT and PT Prior Authorizations
Medicare Advantage – Contact Medicare Part B Specialty Pharmacy before Injections, Infusion Drug Prior Authorization Expire
Medicare Advantage - Inpatient Stays and Observation : Please Help Members Maximize Health Benefit
Precertification for knee and spine orthoses effective July 1, 2016
New precertification request form now available
Medicare Advantage - Notification of Prior Authorization Requirement for Non-Emergency Ambulance Transport for Medicare Advantage, MMP, and D-SNP Members to and from Dialysis Treatment
Scoliosis and Spinal Deformity Medical Necessity Reviews
Medicare Advantage-AIM Oncology and Oncology Drugs
Medical policies update
Medicare Advantage - UPDATED: Skilled Nursing Facilities, Home Health and Long-term Care Facilities: OrthoNet OT and PT Prior Authorization Delayed until Further Notice
Quarterly Pharmacy Formulary Change Notice
Medicare Advantage - DSNP Training Required
Medicare Advantage - Quality Programs Support Patient Safety, Health Improvement
Medicare Advantage - AIM to Conduct Medical Necessity Reviews for Vascular Ultrasound Procedures
Medicare Advantage - Reminder to include the “Rendering Provider Location” for Radiology Services
Medicare Advantage - Quarterly Update to the Medicare Physician Fee Schedule
Medicare Advantage - AIM OptiNet imaging provider registration Frequently Asked Questions
Medicare Advantage - Additional Radiation Oncology Prior Authorizations Should Be Directed to AIM Effective July 1, 2016
Medicare Advantage - UPDATED: Imaging Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage - Two ID Cards Were Issued to DSNP Members 2/25/2016
Zika Virus resources - 2/11/2016
Medicare Advantage - New Prior Authorization Requirements Effective May 1, 2016
Medicare Advantage - Member Incentive for Wellness Visit
Medicare Advantage - UPDATE: Contact AIM for Outpatient Radiation Oncology Prior Authorization
Custom molded orthotics precertification
Medicare Advantage - Accurate Information about Your Practice
Medicare Advantage - HIPPS Codes Required for SNF and HHA Claims
Medicare Advantage - Contact OrthoNet for OT and PT Precertifications in SNF, HH, and LTC
Medicare Advantage - Medicare Notices and Provider Requirements
Medicare Advantage - Please Review Rx Changes to Help Members Find the Best Medication Values
Medicare Advantage - Additional Support Available for Members with Rare Conditions
Precertification for knee and hip arthroplasty effective May 1, 2016
Precertification for knee arthroscopy effective April 1, 2016
Provider incentives and member benefits reminder
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Quarterly pharmacy formulary change notice
Medicare Advantage - Webinar for all Imaging Providers
Quarterly Formulary Change Notice Effective December 1, 2015
Medicare Advantage - Register for Imaging Site Scores by March 1, 2016, to Avoid Unnecessary Line-Item Denials
Medicare Advantage - Avastin for Ophthalmic Use
Medicare Advantage - More $0 Copay Medication Available to Members with Chronic Conditions
Quality Bulletin 2015
Medicare Advantage - Avoid Denials of Diagnostic Claims by Completing Item 20 (CMS 1500) Correctly
Medicare Advantage - Amerigroup Encourages High-Risk Members to get a Flu Shot
Medicare Advantage - 2016 Plan Changes
Medicare Advantage - Diabetic Supply Changes for 2016
Medicare Advantage - Routine Physicals for 2016
Hemophilia drugs authorization changes effective November 15, 2015
Medicare Advantage - Imaging Site Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage - New 2016 prior authorization requirements effective January 1, 2016
OrthoNet focused claim review program notice and FAQs
Medicare Advantage - Part B Updates for Praluent, Repatha and Sylvant
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Prior authorization required for drugs Entyvio and Cyramza
Medicare Advantage - Precertification update for scoliosis and spine deformity
Behavioral Health: Authorization Requirement Changes Effective October 1, 2015
Cervical Length Screening Guidelines
Home Health Therapy Codes Update Effective September 1, 2015
Medicare Advantage - Radiation Therapy: Select Brachytherapy, IMRT CPT Codes to Require Prior Authorization
Now available: Send Claims Medical Attachments through Availity
Medicare Advantage - Participating Providers: Bill Medicare Part D for Shingles or Tetanus Vaccination Claims
Medicare Advantage - 2015 Retrospective Medical Record Review Program
Medicare Advantage - House Call Program
Medicare Advantage - Post Service Drug Claim Edits Updated
Medicare Advantage - Precertification Required on Part B New Injectables
ICD-10 Coded Authorizations Accepted Effective June 1.
Medicare Advantage - Provider DSNP Training: July 7, 2015
Insulin pen coverage
Advair Formulary Change Notice Effective July 1, 2015
Medicare Advantage - New Precertification Requirements Effective September 1, 2015
Medicare Advantage - Part B Drug Reminder
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage - Precertification Required for Hemophilia Drugs
Pharmacy Formulary Change Notice Effective April 1, 2015​
Medicare Advantage - Recovery Look-Back Period to Align with CMS
Medicare Advantage - Select Cardiac Services to Be Reviewed
Medicare Advantage - Intensive Outpatient Program Services
Rx avoidance and OTC reminder flier​
Phone number change for Part B benefits
Medicare Advantage: Precertification Required on Four New Part B Injectables
Encourage Medicare Advantage Members to Stay Up-to-Date on Preventive Care
Pharmacy Benefit Manager Change to Express Scripts Effective April 1, 2015
OrthoNet to conduct post-service prepay reviews
Medicare Advantage - ClaimCheck Version 55 Upgraded Effective April 1, 2015
Medicare Advantage: Medicare Update to Pneumococcal Vaccine Policy
Medicare Advantage - Clearing House Helps Ensure Timely and Accurate Claims Payment for Vaccines Covered by Medicare Part D
Medicare Advantage: Medicare Immune Globulin Home Infusion Therapy Part B Coverage Reminder
Medicare Advantage national coverage determinations
Medicare Advantage: Amerigroup Community Care, Optum Collaborating To Ensure Members Receive Regular Exams, Preventive Screenings
Medicare Advantage: OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews
New 2015 precertification fax number for skilled nursing, long term acute care and inpatient rehab
Provider Quality Bulletin 2014
Medicare Amerivantage PBM Conversion
PCP Rate Increase Decommissioning Bulletin​
Medicare Advantage: Provider Requirements and Medicare Notices
Medicare Advantage 2015 Annual Notice of Change in Products
Reminder: New Outpatient Imaging Partner Effective Nov. 1​
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
Flu Vaccinations
Medicare Advantage Peer to Peer Changes
Inpatient Readmissions
Encourage Exercise to Prevent Falls
Postponed: Upcoming Disbursement Process Changes
Dental contract update
October 2014 Formulary Change Notice​
Patient360 Lets You Access Member Records in a Few Clicks
Upcoming changes to durable medical equipment precertification requirements
Quarterly Pharmacy Formulary Change Notice
Upcoming Disbursement Process Changes
Vaccines for NJ FamilyCare Plan B, C and D Beneficiaries
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
MLTSS Provider Orientation
Pharmacy First-Fill 15-Day Supply Program and List
Attention Behavioral Health Providers – Please respond to our brief survey to keep us informed of the services your practice currently performs.
Effective July 2014: MLTSS Services Available
June 3-September 9 MLTSS Provider Orientation Invitation
Individualized High-Risk Patient Management
Register Now for Availity
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
Updated CMS 1500 Form
Quarterly Pharmacy Formulary Change Notice
Medicare Advantage Product Highlights Provider Letter
December 2013 Quality Bulletin
Outpatient Therapy Services Precertification Initiative
Provider Quality Management Bulletin
Quarterly Pharmacy Formulary Change Notice
New Website Password Requirements
Medicare Requirements for Outpatient Therapy Claims
August 1 Changes to Precertification Guidelines
We Cover Rapid Strep Tests
Medication Precertification Tool Available Now
The New Electronic Health Risk Assessment Form
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
Survey Shows Members Want Greater Involvement in Care Decisions
2013 Medicare Products Benefits Changes
Access and Availability Standards
Community Workshop Flier
Quarterly Pharmacy Formulary Change Notice
The Medicare Health Outcomes Survey
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
Preventing the Flu
Updated Clinical Practice Guidelines Now Available
May 1, 2013, Change to UniCare CPBs & Guidelines
2013 CAHPS Surveys
Hurricane Sandy Information
Our New Online Provider Directory: Built for Providers and Members
Third-Party Liability Guidance
Do you provide long-term services and supports? We want you on board.
Quarterly Formulary Change Notice

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 Provider Resources & Documents

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Behavioral Health Case Management Flier
Behavioral Health Facility Survey
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Provider Bulletin 2014, Issue 2
Electronic Data Interchange (EDI)
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Cognitive Care Program
Clinical Practice Guidelines Matrix - 2015
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About DMCCU
How to Use DMCCU
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Blood Lead Testing for High-risk Children
Hysterectomy Receipt of Information Form
BH Initial Review Fax Form - Medicaid
BH Concurrent Review Fax Form - Medicare
Sterilization Consent Form
Overpayment Refund Notification Form
Coordination of Care form
Primary Care Provider Reassignment Request (English)
Neuropsychological Testing Request Form
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ICD-10
ICD-10 Billing Procedures Nonhospital
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New Jersey Quick Reference Card
Medicare Quick Reference Card
Provider Dispute, Grievance and Appeal FAQ
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Program Overview
Prenatal Ultrasound Policy/ICD-10 Update
Healther Rewards Provider Flier
expand New Jersey Smiles Dental Program
The American Academy of Pediatrics Risk Assessment Tool​
Guideline on Caries - Risk Assessment and Management
AAP Linking Preventive Oral Health and Primary Care Training
Oral health training for primary care providers
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Provider News Issue 4 2012
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Provider News Issue 1 2015
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Provider News Issue 4 2016
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2017 Quarter 2 Provider Newsletter
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State Medicaid Formulary
Prior Authorization Form
Medical Injectables Prior Authorization
Medicaid Half Tablet Program Drug List
State Hepatitis C Sovaldi Therapy
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Common OTC Medications List
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expand Vendor/Partner Links & Information
Healthplex (Dental Services)
Division of Medical Assistance and Health Services
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Express Scripts Prior Authorization
Superior Vision (formerly Block Vision)
New Jersey

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