Nevada | Providers – Amerigroup

News & Announcements

Hemophilia factor injections to require prior authorization
Tips for Amerigroup’s RMH Prior Auth Process
Access Patient360 directly through the Availity Web Portal
Healthy Rewards Program Flier
Q1 Medical Policies and Clinical Utilization Management Guidelines update
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
Timely Filing Limit Update
Genetic testing services to require prior authorization
Additional information on ClaimCheck upgrade to ClaimsXten
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Notification process reminder
Anesthesia Pain Block Update
Continuous interstitial glucose monitoring to require prior authorization
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Quarterly pharmacy formulary change notice effective May 1, 2017
Quarterly pharmacy formulary change notice effective March 1, 2017
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Quarterly pharmacy formulary change notice effective Feb. 1, 2017
Elective one and two vessel coronary artery bypass graft to require prior authorization
Changes to Amerigroup Community Care rehabilitative mental health prior authorization process
Quarterly pharmacy formulary change notice effective November 1, 2016
QVAR pharmacy formulary change notice effective September 1, 2016
Quarterly pharmacy formulary change notice effective September 1, 2016
2016 Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
Federal nondiscrimination and accessibility update
Precertification update for vascular embolization or occlusion services
Provider revalidation requirement extension
Update: Certain drugs to require prior authorization
Effective November 1, 2016 ClaimsCheck® upgrade to ClaimsXten™
Reminder: Measure members’ body mass index regularly
Quarterly pharmacy formulary change notice effective July 1, 2016
Provider appeal rights
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Precertification for knee and spine orthoses effective July 7, 2016
New vendor available for home sleep studies: Novasom™
Updated hysterectomy acknowledgment form
Update on Pharmacy Prior Authorization Submissions
Scoliosis and Spinal Deformity Medical Necessity Reviews
HCPCS billing update: Avastin for ophthalmology
Provider Newsletter
Measure members’ body mass index regularly
Enhanced Availity eligibility and benefits inquiry
Medical policies update
Diabetic Podiatry Update
Quarterly Pharmacy Formulary Change Notice
Behavioral Healthcare benefits for Amerigroup members
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Precertification for knee arthroscopy effective April 1, 2016
Precertification for knee and hip arthroplasty effective May 1, 2016
Custom molded orthotics precertification
Fluoride Update
Option 1 Healthcare Solutions designated as the exclusive enteral and parental nutrition provider
Advance directives
Hemophilia drugs medical necessity reviews
Quarterly pharmacy formulary change notice
Anesthesia claims billed without a modifier
Quarterly Formulary Change Notice Effective December 1, 2015
Amerigroup Community Care offers web-based physician visits
Orientation Webinars Invite for Applied Behavioral Analysts
Prior authorization required for drugs Entyvio and Cyramza
Home Health Therapy Codes Update Effective November 1, 2015
Cultural Competency Training for Providers
Behavioral Health: Authorization Requirement Changes Effective October 1, 2015
Cervical Length Screening Guidelines
ICD-10 Coded Authorizations Accepted Effective June 1.
Advair Formulary Change Notice Effective July 1, 2015
Q1 Medical Policies and Clinical Utilization Management Guidelines Update​
Innovative Healthcare Delivery Partnership for Non-clinical Transition Care
Pharmacy Formulary Change Notice Effective April 1, 2015​
Medicaid PCP Rate Increase
Adult BMI Information
Patient360 Lets You Access Member Records in a Few Clicks
Pharmacy Benefit Manager Change to Express Scripts, Inc. Effective November 1, 2014​
Upcoming changes to durable medical equipment precertification requirements
Upcoming Disbursement Process Changes
Register Now for Availity
Availity Announcement and Frequently Asked Questions
Coming Soon! Enhanced Online Precertification Tool
Updated CMS 1500 Form
Important Phone Numbers for Providers
Las Vegas Provider Forum Invitation
Reno Provider Forum Invitation
Monthly New Provider Orientation
New Website Password Requirements
August 1 Changes to Precertification Guidelines
Medication Precertification Tool Available Now
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
Updated Clinical Practice Guidelines Now Available
Preventing the Flu
Change to Clinical Utilization Management Guidelines
Proper Claims Submission Reminder
Correct Billing & Coding for Healthy Kids Services

Provider Self-Service


Provider Survey

Please help us improve our provider website by taking this brief survey
Take Survey

 Provider Resources & Documents

expand Behavioral Health
Primary Care and Behavioral Health Providers: Working Together to Treat the Whole Person Flier
Nevada Applied Behavior Analysis Overview
Behavioral Health Practitioner Survey
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 1
Provider Bulletin 2014, Issue 3
Provider Bulletin 2015, Issue 1
expand Clinical Practice Guidelines
2016 Preventive Health Guidelines
expand Disease Management Centralized Care Unit
Contacting DMCCU
Disease Management Referral Form
expand EPSDT
Improving EPSDT Screening for Members
expand Forms
BH Initial Review Fax Form - Medicaid
Psychological Testing Request Form
Overpayment Refund Notification Form
PCP Change Request Form (Spanish)
Precertification Request Form
expand ICD-10
expand Manuals & QRCs
Provider Manual
expand Maternal Child Program
Maternity Notification Form
Prenatal Ultrasound Policy/ICD-10 Update
New separate reimbursement for long-acting, reversible contraception devices
Provider notification letter regarding long-acting, reversible contraceptive devices with FAQ
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 3 2014
Provider News Issue 2 2015​
Provider News Issue 4 2015
Provider News Issue 2 2016
Provider News Issue 4 2016
expand Newsletters - Current
2017 Quarter 2 Provider Newsletter
expand Pharmacy
Natn'l Drug Code FAQs
Synagis Enrollment Form
Clinical Pharmacy Policies
Common OTC Medications List
expand Quality Management
Medicaid QM Desktop Reference Guide
expand Quick Tools
Precertification Lookup Tool
Medical Policies
expand Referral Directories
expand Referral Directories
Nevada South Referral Directory
expand Training Programs
CLIA Training
Cultural Competency Training
Moving Toward Equity in Asthma
expand Tutorials
Precertification Status and Appeals Tutorial
Provider Updates: Account Information
Member Information and Panel Listing
expand Vendor/Partner Links & Information
Quest Diagnostics, Inc. (Laboratory Services)
Scion Dental (Dental)
Office of Consumer Health Assistance
AIM (Diagnostic and Imaging Service Authorizations)
Accredo (Specialty Pharmacy)

Fraud, waste and abuse referrals can be made through the following avenues:

  • Medicare/Medicaid Fraud Hotline
  • Compliance and Ethics Hotline
  • Member Fraud, Waste or Abuse
  • Email

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 Amerigroup's Provider Network

New contract Inquiries:

If you are interested in joining the Amerigroup Community Care network, please send a letter of intent and a W9 via e-mail to or by fax to 1-866-495-8711.

Adding new providers to an existing practice:

If you are already contracted with Amerigroup and would like to add additional providers, please e-mail