New Jersey | Providers – Amerigroup

News & Announcements

Medicaid:

Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
New behavioral health discharge call-in line
February 2020 Medical Policies and Clinical Utilization Management Guidelines update
Prior authorization requirements for angiographic evaluation of stenotic or thrombosed dialysis circuits
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
Acquisition of Beacon Health Options
MCG care guidelines — 24th edition
Prior authorization requirements: new 2020 codes for coverage and precertification
November 2019 Medical Policies and Clinical Utilization Management Guidelines update
Availity Provider Notification
Clinical Criteria Web Posting December 2019
Availity Provider FAQ
Clinical Criteria Web Posting November 2019
Coding tip for psychological and neuropsychological testing
Reminder — laboratory and home infusion therapy reimbursement
New specialty pharmacy medical step therapy HAE requirements
Prior authorization requirements for CardioMEMS
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update
Quarterly pharmacy formulary change notice effective February 1, 2020
Expansion of Specialty Pharmacy Precertification List: Zirabev
InterQual 2019.1 update
Multiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update
Healthcare Quality Patient Assessment Form and Patient Assessment Form
Requesting wound care in the home setting
Clinical Criteria Web Posting September 2019
August 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Prior authorization requirements for E0784, K0553 and K0554
Clinical Criteria Web Posting August 2019
Provider training series
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Outpatient laboratory services — new payment policy
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
New online learning course — What Matters Most: Improving the Patient Experience
Quarterly pharmacy formulary change notice effective November 1, 2019
March 2019 Clinical Utilization Management Guidelines
Clinical Laboratory Improvement Amendments
Clinical Criteria Web Posting July 2019
Drug Screen Testing Update
March 2019 Medical Policies and Clinical Utilization Management Guidelines Update
June 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Pharmacy Benefit Manager Change to IngenioRx
Prior authorization requirements changes effective November 1, 2019
Assisting your patients in managing the Donut Hole
Lowering health risks with no-cost statins
Availity Portal Reminder
Prior authorization requirements for continuous positive airway pressure supplies
InterQual 2019 update
Semi-Annual Cost of Care Review
Customization for IP Cancer Therapy
Clinical Criteria Web Posting Q1 2019
Clinical Criteria Web Posting Q2 2019
Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy
Quarterly pharmacy formulary change notice effective August 1, 2019
Beacon Health Options
January 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Unspecified Diagnosis Code Update
Prepayment clinical validation review process
Amerigroup Community Care Provider Incentive Program: Providers can earn more money
Important IRS tax update
2019 Utilization Management Affirmative Statement concerning utilization management decisions
Changes to medical necessity criteria: Amerigroup Community Care adopts the Anthem Medical Policies for home care in New Jersey effective July 1, 2019
Quarterly pharmacy formulary change notice part II effective May 1, 2019
Revision to Facility Emergency Department reimbursement policy postponed
New Specialty Pharmacy Medical Step Therapy Requirements
Oral Health Training for Primary Care Providers
Quarterly pharmacy formulary change notice effective May 1, 2019
Online registration processes for electronic remittance advices and electronic funds transfers
Correction: Cervical length measurement by transvaginal ultrasound
Medical necessity review for appropriate level of care
November 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Clinical Criteria Updates - Posted 3/6/2019
Clinical Criteria updates
Quarterly pharmacy formulary change notice effective February 1, 2019
Urgent authorization requests
Reminder about nursing facility/skilled nursing facility taxonomy code requirements
September 2018 Medical Policies and Clinical Utilization Management Guidelines Update
July 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Medicaid Provider Fraud Training
Prior authorization requirements for Sublocade
Prior authorization requirements for Subcutaneous Implantable Defibrillator system
Prenatal formulary change notice effective August 1, 2018
Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
Availity Claims Dispute Training Webinar
Cervical length measurement by transvaginal ultrasound
Prior authorization requirements for Part B drug Nivestym
Quarterly pharmacy formulary change notice effective October 1, 2018
Prior authorization requirements for high-level, definitive drug testing
Prior authorization requirements for high-level, definitive drug testing
NJ DSNP Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila
Prior authorization requirements for Interferon beta-1a
Electronic claim payment reconsideration - Effective 09/01/2018
Prior authorization requirements for Somatrem
Personal care services rate increase due to state-mandated Medicaid rates
Prior authorization requirements for Part B drugs: Retacrit, Damoctocog and Ilumya
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
Prior authorization requirements for Azedra (iobenguane I 131) and Poteligeo (mogamulizumab)
Long-Acting Reversible Contraception Update: Effective February 1, 2018
Updated Clinical Practice Guidelines now available online
Prior authorization requirements for Cabazitaxel
Zepatier, cough and cold pharmacy formulary change notice effective June 1, 2018
Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)
Prior authorization requirements for Cabazitaxel
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
ICS pharmacy formulary change notice update: effective April 15
Services requiring prior authorization
Prior authorization requirements for Darzalex drug
Lower extremity vascular intervention codes require prior authorization
Electrical stimulation device to require prior authorization
Prior authorization requirements for Part B drug: Trelstar
Amerigroup Community Care adopts MCG Care Guidelines
Prior authorization requirements for Part B drugs: ZEVALIN and Eptacog
Quarterly pharmacy formulary change notice effective May 1, 2018
Prior authorization requirements for cardiovascular services
Prior authorization requirement update for Mylotarg
Q4 Medical Policies and Clinical Utilization Management Guidelines Updates
Prior authorization requirements for Part B drugs: Mylotarg and Mvasi
AIM Musculoskeletal Guidelines Notice
ICS Pharmacy Formulary Change Notice
Eight injectable drugs will require prior authorization
Medical Policy update - Hyaluronan Injections
Prior Authorization for: Varubi and Fasenra
Prior Authorization for: Rebinyn, Fibryna and Hemlibra
Prior Authorization for: Brineura,Tremfya and Zinplava
New pharmacy prior authorization fax numbers effective April 1, 2018
Elotuzumab to require prior authorization
Age limits pharmacy formulary change notice effective February 1, 2018
Quarterly pharmacy formulary change notice effective 2/1/18
Q3 Medical Policies and Clinical Utilization Management Guidelines Updates
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
Prior authorization requirements for Part B drugs Besponsa and Vyxeos
Effective June 1, 2018, providers will be required to use ProView for credentialing
Mavyret pharmacy formulary change notice effective November 1, 2017
Prior authorization requirements for Part B drugs: Renflexis (infliximab-abda), Rituxan Hyclea (rituximab/hyaluronidase) and Zilretta (triamcinolone acetonide SR)
New review process for not otherwise classified drug code
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Genetic testing initiative
Radiology initiative
Quarterly pharmacy formulary change notice effective November 1, 2017
Orthotics to require prior authorization
Q2 Medical Policies and Clinical Utilization Management Guidelines update
Prior authorization requirements for Part B drug: Imfinzi (durvalumab)
Access and Availability Standards
Prior authorization requirements for Part B drug: Yondelis (trabectedin)
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
Wheelchair component or accessory, not otherwise specified to require prior authorization
Q1 Medical Policies and Clinical Utilization Management Guidelines update
Clinical Practice Guidelines
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Quarterly pharmacy formulary change notice effective May 1, 2017
Genetic testing services to require prior authorization
Additional information on ClaimCheck® upgrade to ClaimsXten™
Quarterly pharmacy formulary change notice effective March 1, 2017
Quarterly pharmacy formulary change notice effective February 1, 2017
ICS pharmacy formulary change reminder - effective August 1, 2016
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Continuous interstitial glucose monitoring to require prior authorization
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
QVAR pharmacy formulary change notice effective September 1, 2016
2016 Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
Quarterly pharmacy formulary change notice effective September 1, 2016
Precertification update 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
Precertification for knee and hip arthroplasty effective May 1, 2016
Precertification for knee arthroscopy effective April 1, 2016
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Quarterly pharmacy formulary change notice
Quarterly Formulary Change Notice Effective December 1, 2015
Quarterly Pharmacy Formulary Change Notice
Zika Virus resources - 2/11/2016
Custom molded orthotics precertification
Pharmacy Benefit Manager Change to Express Scripts Effective April 1, 2015
OrthoNet focused claim review program notice and FAQs
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Cervical Length Screening Guidelines
Hemophilia drugs authorization changes effective November 15, 2015
Precertification for knee and spine orthoses effective July 1, 2016
New precertification request form now available
Now available: Send Claims Medical Attachments through Availity
Advair Formulary Change Notice Effective July 1, 2015
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
Pharmacy Formulary Change Notice Effective April 1, 2015​
PCP Rate Increase Decommissioning Bulletin​
Postponed: Upcoming Disbursement Process Changes
Dental contract update
Patient360 Lets You Access Member Records in a Few Clicks
Upcoming changes to durable medical equipment precertification requirements
Vaccines for NJ FamilyCare Plan B, C and D Beneficiaries
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.
Register Now for Availity
A New Sleep Study Management Program for In-Home Sleep Testing (HST)
Availity Announcement and Frequently Asked Questions
Updated CMS 1500 Form
Outpatient Therapy Services Precertification Initiative
We Cover Rapid Strep Tests
August 1 Changes to Precertification Guidelines
Medication Precertification Tool Available Now
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
Community Workshop Flier
Do you provide long-term services and supports? We want you on board.

Medicare:

Updates to AIM musculoskeletal program clinical appropriateness guidelines for all lines of business
Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
Medicare Advantage - February 2020 Medical Policies and Clinical Utilization Management Guidelines Update
Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline
Special Needs Plans (SNPs) and Model of Care (MOC) overview
Medicare Advantage — Modifier use reminders
Medicare Advantage Resources supporting our providers during COVID-19
Medicare Advantage Clinical Criteria Web Posting February 2020
Amerigroup expands specialty pharmacy precertification list
Medicare Advantage — Amerigroup working with Optum to collect medical records for risk adjustment
Amerigroup expands specialty pharmacy precertification list
Medicare Advantage MCG care guidelines — 24th edition
Medicare Advantage - Prior authorization requirements
New behavioral health Medicare Advantage provider fax beginning March 30, 2020
Medicare Advantage – 2019 Annual Notice of Change
Medicare Advantage - Prior authorization requirements: new 2020 codes for coverage and precertification
Medicare Advantage Clinical Criteria Web Posting December 2019
Medicare Advantage - November 2019 Medical Policies and Clinical Utilization Management Guidelines update
New Medicare Advantage Opioid Treatment Program benefit
Medicare Advantage - Coding tip for psychological and neuropsychological testing
Medicare Advantage Clinical Criteria Web Posting November 2019
Update on Personal Home Helper supplemental benefit for Medicare Advantage Members
Procedures for submitting referrals for Medicare Advantage embedded supplemental benefits requiring precertification
Procedures for submitting referrals for Medicare Advantage meal benefits requiring precertification
Benefits update for Special Supplemental Benefits for the Chronically Ill
Medicare Advantage - Everyday Extras — personal home helper
New CMS requirement: Hospitals must use Medicare Outpatient Observation Notice
Personal Home Helper benefits
2020 Medicare risk adjustment provider trainings
New Specialty Part B Preferred Device - Effective January 17, 2020
Medicare New Specialty Pharmacy Medical Step Therapy Requirements - Effective January 17, 2020
Medicare Advantage - Clinical Criteria Web Posting September 2019
Medicare Advantage: Pharmacy Benefit Manager Change to IngenioRx - Effective 1/1/2020
NJ 2020 Medicare Advantage plan changes
Medicare Advantage - August 2019 Medical Policies and Clinical UM Guidelines update
Medicare Advantage - CMS reminder: expedited/urgent requests
Medicare Advantage - Aspire Telehealth Palliative Care Program bulletin 
Medicare Advantage - June 2019 Medical Policies and Clinical UM Guidelines update
Prior Auth Q2 2019 Medicare CoC Rule Changes-AGP
2019 Enhanced Personal Health Care Program releases myFHR
Medicare Advantage - Medicare Preferred Cont Glucose Monitors
Medicare Advantage - 2019 Risk Adjustment Provider Trainings
Medicare Advantage – January 2019 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – March 2019 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – CLIA for Amerigroup
Medicare Advantage – Pharmacy benefit manager change to IngenioRx
Medicare Advantage – Clinical Criteria Web Posting Q1 2019
Medicare Advantage- AGP Customization for IP Cancer Therapy
Medicare Advantage – Clinical Criteria Web Posting Q2 2019
Medicare Advantage – Notice of change in Medicare Advantage non-PCP reimbursement status
Upgrade to 23rd Edition of MCG Care Guidelines
Update to Emergency Department: Level of E&M Services Reimbursement Policy (Medicare-Advantage Only)
Medicare Advantage – Medical records request for risk adjustment
Update: Medicare Advantage – 2019 risk adjustment provider trainings
Update: Medicare Advantage – Submitting corrected claims
Medicare Advantage – Partial hospitalization services
Medicare Advantage – Fall prevention tips
Medicare Advantage – Prior authorization requirements for DME repair and portable oxygen concentrator
Medicare Advantage - Update: 2019 Risk Adjustment provider trainings
Medicare Advantage – Change to 835 ERA for all D-SNP MA members for 2019
Medicare Advantage – Special Need Plans training required
Medicare Advantage – Clinical criteria updates for specialty pharmacy
Medicare Advantage – Amerigroup eye refraction and routine eye exam billing information
Medicare Advantage – Pharmacy and Therapeutic Committee updates
Medicare Advantage – Medicare Advantage – Use grouped CPT codes for AIM Specialty Health authorizations
Medicare Advantage – Member Explanation of Benefits redesigned
Medicare Advantage – New specialty Part B device Voluntary Steerage program
Medicare Advantage – 2019 Risk Adjustment Training
Medicare Advantage – Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – New provider learning opportunity: Put the ProviderPortal to work for you
Medicare Advantage – New provider service phone number beginning January 1, 2019
Medicare Advantage - CMS Preclusion List effective April 1, 2019
Medicare Advantage - When and how to initiate reopenings
Medicare Advantage - Plans to move compound drugs off formulary beginning January 1, 2019
Medicare Advantage - Part B drugs may include Step Therapy beginning January 1, 2019
Medicare Advantage - New MA plans, service area expansions effective January 1, 2019
Medicare Advantage – Genetic testing prior authorization by ordering physician helps ensure accurate lab payment
Medicare Advantage – Amerigroup transitions back pain management and cardiology UM programs from OrthoNet to AIM
Medicare Advantage – Please evaluate statin use for MA members with diabetes, cardiovascular disease
Medicare Advantage – Medicare pharmacy and prescriber home starts January 2019
Medicare Advantage – Prior authorization requirements for Part B drugs: Nivestym
Medicare Advantage – Electronic Claim Payment Reconsideration
Medicare Advantage – Prior authorization requirements for high level definitive Drug Testing(s)
Medicare Advantage – Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila
Medicare Advantage CMS issues regulatory changes for short- and long-acting narcotics; days’ supply limits effective Jan. 1, 2019
Medicare Advantage – DME providers and physicians: important wheelchair prior authorization information
Medicare Advantage – Submit PA medication requests electronically; new phone number for MA prescription Pas effective Sept. 1
Medicare Advantage – Members receive incentives for completing screenings
Medicare Advantage – Amerigroup adopts Milliman Care Guidelines for inpatient rehabilitation, subacute rehabilitation and skilled nursing facility clinical reviews
Medicare Advantage – Inpatient Readmissions Medicare Advantage Update
Medicare Advantage – Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – Prior authorization requirements for Part B drugs Retacrit, Damoctocog and Ilumya
Medicare Advantage – MyDiversePatients.com
Medicare Advantage – Medical Policies Update
Medicare Advantage – Prior authorization requirements for Part B drugs: Azedra and Poteligeo
Medicare Advantage – Peer-to-Peer Process
Medicare Advantage – Amerigroup adopts MCG care guidelines
Medicare Advantage – Prior authorization requirements for Cardiovascular Services
Medicare Advantage – CMS Selects Amerigroup for 2016 National RADV Audit
Medicare Advantage – Cologuard covered for Medicare Advantage members
Medicare Advantage – Prior authorization requirement for Electrical Stimulation Device
Medicare Advantage – Prior authorization requirements for part B drugs: Zevalin and Eptacog
Medicare Advantage – Prior authorization requirements for part B drug: Trelstar
Medicare Advantage – myNexus Network Contracting FAQ
Medicare Advantage – Utilization management decisions based on appropriateness of care, benefits
Medicare Advantage – Prior authorization requirements for CAR-T Therapy
Medicare Advantage – Amerigroup to conduct post-payment reviews of distinct procedural services modifiers
Medicare Advantage – Amerigroup to conduct post-payment reviews of distinct procedural services modifiers
Medicare Advantage – Prior authorization requirements for part B drugs: Mylotarg and Mvasi
Medicare Advantage – Prior authorization requirements for injectable drugs: Brineura, Tremfya and Zinplava
Medicare Advantage – Prior authorization requirements for Part B drugs: Rebinyn, Fibryna and Hemlibra
Medicare Advantage – 2018 Annual Notice of Change
Medicare Advantage – Members to Receive Gift Cards Diabetic Retinal Eye Exams
Medicare Advantage - Inpatient Readmissions Update
Medicare Advantage - Prior Authorization Requirements for Erelzi, Amjevita, Voretigene neparvovec, Nanacog and Lartruvo
Medicare Advantage – In Home Visits Available for Members with Chronic and Complex Conditions
Medicare Advantage - Required Billing Updates for Rural Health Clinics: HCPCS Codes Required for all RHC Claims
Medicare Advantage - Required Billing Updates for Rural Health Clinics: HCPCS Codes Required for all RHC Claims
Medical policies update
Medicare Advantage - Member Incentive for Wellness Visit
Medicare Advantage - Radiation Therapy: Select Brachytherapy, IMRT CPT Codes to Require Prior Authorization
Medicare Advantage - House Call Program
Medicare Advantage - Provider DSNP Training: July 7, 2015
Medicare Advantage: Precertification Required on Four New Part B Injectables
Medicare Advantage: Provider Requirements and Medicare Notices
Medicare Advantage 2015 Annual Notice of Change in Products
Flu Vaccinations
Medicare Advantage Peer to Peer Changes
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
Inpatient Readmissions
Encourage Exercise to Prevent Falls
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Individualized High-Risk Patient Management
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Medicare Advantage Product Highlights Provider Letter
Medicare Requirements for Outpatient Therapy Claims
The New Electronic Health Risk Assessment Form
2013 Medicare Products Benefits Changes 
The Medicare Health Outcomes Survey
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
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
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