New York | Providers – Amerigroup

News & Announcements

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
expand Autism Resource Guides
Autism Resource Guide - English
Autism Resource Guide - Chinese
expand Behavioral Health
Primary Care and Behavioral Health Providers: Working Together to Treat the Whole Person Flier
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 1
Provider Bulletin 2014, Issue 3
expand Clinical Practice Guidelines
expand Disease Management Centralized Care Unit
About DMCCU
How to Use DMCCU
expand EPSDT
EPSDT Provider Training
expand Forms
Training Verification Form
Practitioner Clinical Medical Record Audit
Claim Payment Appeal Submission
Diabetes Treatment Plan
Precertification Request
Mental Health Substance Abuse Screening
Discharge Note Fax Form
BH Initial Review Fax Form - Medicaid
expand Health Home
Provider FAQs
Health Homes Flier
expand ICD-10
expand Manuals & QRCs
Medicare Advantage Quick Reference Card
NY MA MAP Provider Manual Addendum
2015 NY Medicare Provider Manual Updates
expand Maternal Child Program
17P Frequently Asked Questions
Maternity Notification Form
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters
Provider News Issue 3 2012
Provider News Issue 1 2013
Provider News Issue 3 2013
Provider News Issue 3 2014
expand Pharmacy
Standard Pharmacy Prior Authorization Form
Pharmacy Tools
Synagis Enrollment Form
Preferred Drug List
Medical Injectables Prior Authorization
Sovaldi Prior Authorization Criteria
expand Quality Management
expand Quick Tools
Reimbursement Policies
expand Training
DSNP Overview Training
expand Training Programs
EPSDT Screening Education for PCPs
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
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 www.Availity.com to register today.

Visit Frequently Asked Questions about Availity for more information.

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  • For all other claims, log in above!

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If you’re interested in joining our network, request an application below. Once you start the process, a Provider Relations representative will contact you.

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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.