New York | Providers – Amerigroup

Our name is changing!

Attention Medicaid and FIDA providers: Effective October 1, 2015, HealthPlus Amerigroup is now Empire BlueCross BlueShield HealthPlus (Empire). Visit the new Empire Medicaid provider website Make sure to update your bookmarks!
Medicare: Because this website also serves Medicare providers, it will be live until December 31, 2015.

News & Announcements

Medicare Advantage - Amerigroup Encourages High-Risk Members to get a Flu Shot
Oct. 30 Jackson Heights PAVE Appreciation Networking Breakfast
Nov. 18 Hempstead PAVE Appreciation Networking Breakfast
Prior authorization required for drugs Entyvio and Cyramza
MMP: Behavioral Health: Authorization Changes Effective October 1, 2015
Experimental/Investigational Services
Precertification update for scoliosis and spine deformity
Behavioral Health: Authorization Requirement Changes Effective October 1, 2015
Claims Testing Alert
Cervical Length Screening Guidelines
Home Health Therapy Codes Update Effective September 1, 2015
Mainstream Medicaid and HARP Orientation at 14 Wall St
Mainstream Medicaid and HARP Orientation Online
Sick Baby Authorization and Newborn DRG
Precertification for Part B Drugs Entyvio and Cyramza
Brooklyn PAVE Education and Provider Appreciation Breakfast
Bronx PAVE Education and Provider Appreciation Breakfast
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
Clarification to OB/GYN benefit
Medical Necessity Reviews for Spinal Surgery and Back Pain Management
ICD-10 Coded Authorizations Accepted Effective June 1.
Step Therapy and Quantity Limit Update​
Frequency limits on Dual-energy X-ray Absorptiometry (DXA) scans​
Focused Claim Review Program Questions and Answers
Medicare Advantage - Provider DSNP Training: July 8, 2015
Effective, June 9, 2015, OrthoNet to conduct professional service coding reviews for musculoskeletal providers
Spinal Surgery and Pain Management Program
Expanded benefits and HARP effective October 1, 2015
Medicare Advantage - New Precertification Requirements Effective September 1, 2015
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
Orthopedic Footwear L-Codes Memo
Medicare Advantage - Part B Drug Reminder
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
Coverage of low dose CT scans for lung cancer
Coverage of Oncotype Diagnostic Test for Breast Cancer
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
MMP: Precertification Required on Four New Part B Injectables
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
OrthoNet to Conduct Musculoskeletal Coding Reviews
Medicare Advantage: Medicare Immune Globulin Home Infusion Therapy Part B Coverage Reminder
Medicare Advantage national coverage determinations
Medicare Advantage: HealthPlus, and Amerigroup Company, 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
Medicare Amerivantage PBM Conversion
Medicare Advantage: Provider Requirements and Medicare Notices
PCP Rate Increase Decommissioning Bulletin
Medicare Advantage 2015 Annual Notice of Change in Products
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
October 2014 Formulary Change Notice​
Patient360 Lets You Access Member Records in a Few Clicks
Upcoming changes to durable medical equipment precertification requirements
Patient360 Lets You Access Member Records in a Few Clicks
Quarterly Pharmacy Formulary Change Notice
Provider Network Closure
Upcoming Disbursement Process Changes
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Important Information Regarding Pharmacy Network Disruption Letter Sent to Members from June 5-10, 2014
Insulin Pump Prescription Reminder - Omnipod Not Covered
Medicare Advantage Members to Receive Monthly Summary Statements
Individualized High-Risk Patient Management
Pharmacy First-Fill 15-Day Supply Program and List
Genetic Testing Update
Follow Up Hospitalization
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
Coming Soon! Enhanced Online Precertification Tool
Updated CMS 1500 Form
Quarterly Pharmacy Formulary Change Notice
Elective Delivery Policy Change Reminder
Medicare Advantage Product Highlights Provider Letter
Well-Woman Exams Reminder
Quarterly Pharmacy Formulary Change Notice
New Website Password Requirements
Cooling Center Reminder
Medicare Requirements for Outpatient Therapy Claims
Meningitis Vaccine Reminder
Medication Precertification Tool Available Now
The New Electronic Health Risk Assessment Form
Your Quick Start Guide to Serving Legacy Empire CHPlus Members
Specialty Pharmacy Update
Reminder: Benefits Added for Long-Term Care Members
7/1/13 HealthPlus Amerigroup to serve Empire CHP members in Suffolk and Westchester Cos.
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
Quarterly Pharmacy Formulary Change Notice
Upcoming Changes to Precertification Requirements
The Medicare Health Outcomes Survey
Update: Change to Clinical Utilization Management Guidelines
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
4/1/13: HealthPlus Amerigroup to Serve Empire CHPlus Members in NYC and Nassau Co.
Prepayment Reviews for Amerivantage Inpatient Readmission Claims
Our Preferred Lab Vendors
Important Notice: Medicare Advantage Sequestration
Autism Resource Guides Now Available
Preventing the Flu
Updated Clinical Practice Guidelines Now Available
2013 CAHPS Surveys
2013 Medicare Products and Benefit Changes
Hurricane Sandy Relaxed Precertifications End
Transportation Services Update
Our Medicaid ID Cards Have Gone Mobile!
Screening, Treatment and Diagnosis of Autism Spectrum Disorder for Child Health Plus Members
Our New Online Provider Directory: Built for Providers and Members
Changes to New York Medicaid Benefits
HealthPlus Amerigroup Mammography Self-Referral
National Drug Code (NDC) Reporting Requirements
Click here for information about X12 version 5010 compliance standards and testing.
Print-on-Demand ID cards now available on our member website

Provider Self-Service

 Provider Resources & Documents

expand NY FIDA
FIDA Precertification request form​
BH Concurrent Review Form
BH Coordination of Care Form
FIDA Reimbursement Policies
Psychological Testing Request Form
expand Autism Resource Guides
Autism Resource Guide - Spanish
expand Behavioral Health
Behavioral Health Quick Reference Grid
Behavioral Health Case Management Flier
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
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
Training Verification Form
Practitioner Clinical Medical Record Audit
Claim Payment Appeal Submission
Diabetes Treatment Plan
Precertification Request
BH Concurrent Review Fax Form - Medicaid
BH Initial Review Fax Form - Medicare
BH Concurrent Review Fax Form - Medicare
Practice Profile Update Form
Psychological Testing Request Form - Medicaid and Medicare
expand Health Home
Community Referrals for Health Home Services
expand ICD-10
expand Manuals & QRCs
Medicare Advantage Quick Reference Card
Medicaid/FHP/CHPlus Provider Manual
expand Maternal Child Program
Program Overview
17P Order Form
Prenatal Ultrasound Policy
expand Medical Management Model
Health Education and Wellness
expand Newsletters
Provider News Issue 2 2012
Provider News Issue 4 2012
Provider News Issue 2 2013
Provider News Issue 4 2013
Provider News Issue 1 2015
Provider News Issue 3 2015
expand Pharmacy
Medicaid/FHP/CHPlus Formulary
Medicare Formulary
Clinical Pharmacy Policies
Natn'l Drug Code FAQs
Common OTC Medications List
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
expand Quick Tools
Reimbursement Policies
expand Training Programs
EPSDT Screening Education for PCPs
DSNP Plans for 2015 FAQ
expand Tutorials
Claims Appeals Tutorial
Precertification Status and Appeals Tutorial
Precertification Request Tutorial
Member Information and Panel Listing
expand Vendor/Partner Links & Information
Healthplex (Dental Services)
LogistiCare Solutions LLC (Nonemergent Transportation)
New York State Medicaid Website
ESI Pharmacy Locator Tool
AIM (Diagnostic and Imaging Service Authorizations)
PHQ9 Screening Tool
Superior Vision (formerly Block Vision)
New York

Do more online by registering for Provider Self-Service

Through Provider Self-Service, you can:

  • 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.

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Join Our Network

Do you specialize in Applied Behavior Analysis (ABA)? We want you on board.
If you’re interested in joining our network, request an application below. Once you start the process, a Provider Relations representative will contact you.

Already in our network?
If you’d like to update your credentials to include ABA or an autism spectrum disorder-related specialty, contact your Provider Relations representative or call Provider Services.