New Jersey | Providers – Amerigroup

News & Announcements

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
expand Disease Management Centralized Care Unit
How to Use DMCCU
expand Enhanced Personal Health Care Program
Measurement Period Handbook
Program Overview
expand EPSDT
EPSDT Provider Training
expand Forms
Practitioner Clinical Medical Record Audit
Precertification Request Form
Sterilization Consent Form
BH Initial Review Fax Form - Medicaid
BH Concurrent Review Fax Form - Medicare
expand ICD-10
expand Manuals & QRCs
New Jersey Quick Reference Card
Medicare Quick Reference Card
Medicaid & Medicare QM Desktop Reference Guide
expand Maternal Child Program
17P Order Form
Program Overview
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​
expand Pharmacy
Clinical Pharmacy Policies
State Preferred Drug List (PDL)
Natn'l Drug Code FAQs
Common OTC Medications List
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
Medicaid and Medicare QM Desktop Reference Guide
expand Quick Tools
Reimbursement Policies
expand Referral Directories
New Jersey Medicaid Referral Directory
expand Training
DSNP Overview Training
expand Training Programs
Cultural Competency
expand Tutorials
Precertification Status and Appeals Tutorial
Provider Updates: Account Information
Member Information and Panel Listing
expand Vendor/Partner Links & Information
LabCorp (Laboratory Services)
AIM (Diagnostic and Imaging Service Authorizations)
Express Scripts Provider Portal - Medicare
Express Scripts Provider Portal
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 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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