New Jersey | Providers – Amerigroup

News & Announcements

New precertification request form now available
Medicare Advantage - Impatient Stays and Observation : Please Help Members Maximize Health Benefit
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 - Providers Must Enroll with Medicare to Prescribe Part D
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

Provider Self-Service

 Provider Resources & Documents

expand Behavioral Health
Behavioral Health Case Management Flier
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 2
Electronic Data Interchange (EDI)
expand Clinical Practice Guidelines
Cognitive Care Program
expand Disease Management Centralized Care Unit
About DMCCU
How to Use DMCCU
expand Enhanced Personal Health Care Program
Measurement Period Handbook
Program Description for the EPHC
expand EPSDT
EPSDT Provider Training
expand Forms
Specialist as PCP
BH Initial Review Fax Form - Medicare
BH Concurrent Review Fax Form - Medicaid
Psychological Testing Request Form
Recoupment Notification Form
Outpatient Precertification Request Form
Precertification Form (DME, skilled home care, home infusion, pain management, hyperbaric, hospice, dialysis and chiropractic care)
expand ICD-10
ICD-10 Billing Procedures Hospital
Medicare ICD-10 Coding Changes
expand Manuals & QRCs
New Jersey Provider Manual
2015 Medicare Provider Manual Updates
expand Maternal Child Program
17P Order Form
Prenatal Ultrasound Policy
Prenatal Ultrasound Policy/ICD-10 Update
expand New Jersey Smiles Dental Program
New Jersey Smiles Directory
Caries Risk Assessment Form (Birth-Age 6)
Children’s fluoride varnish application for nondental providers
expand Newsletters
Provider News Issue 2 2012
Provider News Issue 3 2012
Provider News Issue 4 2013
Provider News Issue 3 2014
Provider News Issue 2 2015​
Provider News Issue 3 2013
Provider News Issue 1 2016
expand Pharmacy
State Medicaid Formulary
Prior Authorization Form
Medical Injectables Prior Authorization
Synagis Enrollment Form
Clinical Pharmacy Policies
expand Quality Management
HEDIS® 101 for Providers: Improving Quality of Care
Medical Record Review Audit Tool
expand Quick Tools
Precertification Lookup Tool
Medical Policies
expand Referral Directories
New Jersey Medicaid Referral Directory
expand State Resources
Interim Managing Entity (IME) Website
expand Training Programs
DSNP Overview Training
expand Tutorials
Claims Appeals Tutorial
Precertification Request Tutorial
Medication Precertification Tutorial
expand Vendor/Partner Links & Information
Healthplex (Dental Services)
Division of Medical Assistance and Health Services
ESI Pharmacy Locator Tool
Express Scripts Prior Authorization
Superior Vision (formerly Block Vision)
New Jersey

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 www.Availity.com to register today.

Visit Frequently Asked Questions about Availity for more information.

Join the Amerigroup Network

If you’re a long-term services and supports provider, we have a home for you. In addition to PCPs and specialists, we’re currently credentialing:

  • Nursing home services
  • Adult day care
  • Home care
  • Personal care services
  • Skilled nursing services
  • Assisted living services
  • Home delivered meals
  • Environmental accessibility adaptations
  • Vehicle modification
  • Behavioral health services

We want you on board. Learn more about us or request an application below.


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