New Mexico | Providers – Amerigroup

News & Announcements

Medicare Advantage – Noncovered Services FAQs
Medicare Advantage – Prior Authorization for Genetic Testing for Members Effective Nov. 1
Medicare Advantage – Prior authorization requirement change for part B drug Yondelis
Medicare Advantage – Prior authorization requirement change for part B drug Imfinzi
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
Medicare Advantage - Imaging Services Providers Must Complete OptiNet Assessments to Avoid Line-item Denial
Medicare Advantage – Home Health Services to Require Prior Authorization
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
Inpatient Readmissions Update
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 - CMS Selects Amerigroup for 2015 National RADV Audit
Medicare Advantage - Prior Authorization Requirements for Part B Drug - Exondys 51
Medicare Advantage - Prior Authorization Requirements for Part B Drug - Evomela
Medicare Advantage – AIM OptiNet Registration FAQ
Medicare Advantage - Complete your AIM OptiNet® registration services by April 1, 2017
Medicare Advantage - Providers Must Enroll with Medicare to be able to Prescribe Part D Beginning January 1, 2019
Medicare Advantage - CMS Emergency Preparedness Rule
Medicare Advantage - HEDIS Measure: Ensure Medication Reconciliation is Completed after Discharge
Medicare Additional information on ClaimCheck® upgrade to ClaimsXten™
Medicare Advantage - Radiation Therapy Services – Contact AIM for Delivery, Amerigroup for Planning
Medicare Advantage - Transitional Care Management (TCM) Services
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
Medicare Advantage - Additional Information on ClaimCheck Upgrade to ClaimsXten
Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
Medicare Advantage - Prior Authorization Requirement Change to Epidermal Growth Factor Receptor Testing
Medicare Hospital observation service limits
Medicare Advantage – Transitional Care Management Services Eligibility
Medicare Advantage - Hospitals must use Medicare Outpatient Observation Notice
Medicare Advantage – 2017 Annual Notice of Change
Medicare Advantage – Verify Injectable, Infusion Billable Units Approved via AIM
Medicare Advantage - Routine Physical Exams are Covered in 2017
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
Medicare Advantage - Care Program Available for Members Facing Advanced Illness
Medicare Advantage - Prior Authorization Requirements for Cuvitru, Ocrevus and Lutathera
Medicare Advantage - Prior Authorization Requirements for Intracardiac Electrophysiological Studies and Catheter Ablation
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
Controlling high blood pressure
2016 Medicare Clinical Practice Guideline Matrix
Medicare Advantage - Clarification for Requesting Authorization for certain Arterial Duplex Imaging Procedures
Medicare Advantage - Prior Authorization Requirements for Continuous Interstitial Glucose Monitoring
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
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
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 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 - AIM Clinical Appropriateness Guidelines for Advanced Imaging effective November 1, 2016
Medicare Advantage - Prior Authorization for Emend (Fosaprepitant), Aloxi (Palonosetron), and Afstyla (Antihemophilic)
Medicare Advantage - Member Incentive for Annual Routine Physical
Medicare Advantage - Prior Authorization Requirements for Vascular Embolization or Occlusion Services
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
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
Medicare Advantage-AIM Oncology and Oncology Drugs
Medicare Advantage - UPDATED: Skilled Nursing Facilities, Home Health and Long-term Care Facilities: OrthoNet OT and PT Prior Authorization Delayed until Further Notice
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 - New Prior Authorization Requirements Effective May 1, 2016
Medicare Advantage - UPDATE: Contact AIM for Outpatient Radiation Oncology Prior Authorization
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
Medicare Advantage - Webinar for all Imaging Providers
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
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
Medicare Advantage 2016 Service Area Changes
Medicare Advantage - Imaging Site Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage - New 2016 prior authorization requirements effective January 1, 2016
Medicare Advantage - Part B Updates for Praluent, Repatha and Sylvant
Medicare Advantage - Precertification update for scoliosis and spine deformity
Medicare Advantage - Radiation Therapy: Select Brachytherapy, IMRT CPT Codes to Require Prior Authorization
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 - New Precertification Requirements Effective September 1, 2015
PCP Medicaid Rate Increase
Medicare Advantage - RAVD and Provider Obligations
Medicare Advantage - Part B Drug Reminder
Medicare Advantage - Precertification Required for Hemophilia Drugs
Medicare Advantage - Recovery Look-Back Period to Align with CMS
Medicare Advantage - Select Cardiac Services to Be Reviewed
Medicare Advantage - Intensive Outpatient Program Services
Phone number change for Part B benefits
Medicare Advantage: Precertification Required on Four New Part B Injectables
Medicare Advantage: OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews
Encourage Medicare Advantage Members to Stay Up-to-Date on Preventive Care
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, Inc., Optum Collaborating To Ensure Members Receive Regular Exams, Preventive Screenings
New 2015 precertification fax number for skilled nursing, long term acute care and inpatient rehab
Medicare Amerivantage PBM Conversion
Medicare Advantage: Provider Requirements and Medicare Notices
Medicare Advantage 2015 Annual Notice of Change in Products
Patient360 Lets You Access Member Records in a Few Clicks
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
Flu Vaccinations
Service Area Change Fax
Medicare Advantage Peer to Peer Changes
Inpatient Readmissions
Encourage Exercise to Prevent Falls
Postponed: Upcoming Disbursement Process Changes
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Bone Density Testing for Medicare Members
Medicare Advantage Members to Receive Monthly Summary Statements
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Medicare Advantage Product Highlights Provider Letter
New Website Password Requirements
Medicare Requirements for Outpatient Therapy Claims
August 1 Changes to Precertification Guidelines
The New Electronic Health Risk Assessment Form
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
Thank You For Being Part of Our Network
The Medicare Health Outcomes Survey
Updated Clinical Practice Guidelines Now Available
DRG Version 30 Effective Retroactive to October 2012
Change to Clinical Utilization Management Guidelines
2013 CAHPS Surveys

Provider Self-Service

 Provider Resources & Documents

expand Behavioral Health
Behavioral Health Case Management Flier
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 3
expand Clinical Practice Guidelines
Clinical Practice Guidelines Matrix
expand Disease Management Centralized Care Unit
Contacting DMCCU
expand Enhanced Personal Health Care Program
Medicare Advantage Medical Panels
Program Overview
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EPSDT Reminder Program
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Provider Demographic Update
BH Initial Review Fax Form - Medicare
Recoupment Notification Form
expand ICD-10
ICD-10
Medicare Record Documentation & Coding Tips
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CoLTS Provider Manual
Medicare Provider Manual
expand Maternal Child Program
Maternity Notification Form
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters - Archived
Provider News Issue 3 2012
Provider News Issue 1 2013
Provider News Issue 2 2015​
Provider News Issue 4 2015
Provider News Issue 2 2016
Provider News Issue 4 2016
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2017 Quarter 2 Provider Newsletter
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Pharmacy Prior Authorization Form
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Medicare QM Desktop Reference Guide
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Precertification Lookup Tool
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Claims Appeals Tutorial
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Medication Precertification Tutorial
Cultural Competency Toolkit
expand Vendor/Partner Links & Information
Quest Diagnostics, Inc. (Laboratory Services)
AIM (Diagnostic and Imaging Service Authorizations)
Superior Vision (formerly Block Vision)
New Mexico

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