Tennessee | Providers – Amerigroup

News & Announcements

2016 provider expo – East Tennessee region
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
Emergency department (ED) diversion case management program
Marshall and Wayne Medical Centers will no longer be in network
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 - Care Program Available for Medicare Advantage Members Facing Advance Illness
Last Chance to Enroll in the TennCare Medicaid EHR Provider Incentive Program
2016 Provider exhibition – Middle Tennessee region
Reimbursement Policy Bulletin - April 2016
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 - DSNP Training Required
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 - UPDATED: Imaging Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage – OptiNet webinar for all imaging providers
Medicare Advantage - HealthMap Solutions Gathering Diabetes Screening Results
2016 provider webinars
Presentation for Prospective Employment and Community First CHOICES providers
Medicare Advantage - New Prior Authorization Requirements Effective May 1, 2016
Durable medical equipment precertification requirements
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
ER Services During Inpatient Psychiatric Admission
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
Consent for Sterilization Form Approved for Continued Use
Medicare Advantage - Avoid Denials of Diagnostic Claims by Completing Item 20 (CMS 1500) Correctly
Revalidate Your Registration
Medicare Advantage - Providers Must Enroll with Medicare to Prescribe Part D
Prior authorization required for drugs Entyvio and Cyramza
Medicare Advantage - Amerigroup Encourages High-Risk Members to get a Flu Shot
Electronic Registration/Revalidation Required
Scoliosis and spinal deformity medical necessity reviews
Medicare Advantage - 2016 Plan Changes
Tramadol: Drug safety communication
Medicare Advantage - Diabetic Supply Changes for 2016
Medicare Advantage - Routine Physicals for 2016
Medicare Advantage 2016 Service Area Changes
Hemophilia drugs authorization changes effective November 15, 2015
Changes to Level 2 Case Management Guidelines
Medicare Advantage - Imaging Site Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage - New 2016 prior authorization requirements effective January 1, 2016
Retraction of Nonphysician Practitioner Reimbursement Policy
2015 Provider Webinars
Medicare Advantage - Part B Updates for Praluent, Repatha and Sylvant
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Correction to Marshall and Wayne Medical Centers notification
Medicare Advantage - Precertification update for scoliosis and spine deformity
Behavioral Health: Authorization Requirement Changes Effective October 1, 2015
Cervical Length Screening Guidelines
Home Health Therapy Codes Update Effective September 1, 2015
Amerivantage Specialty + Rx Plan now available for eligible members with Medicare and Medicaid coverage​
Medicare Advantage - DSNP Training Invite
Please take our provider survey regarding members with I/DD
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
What is defined as a Critical Incident is changing
ICD-10 Coded Authorizations Accepted Effective June 1.
OrthoNet to conduct professional service coding reviews for musculoskeletal providers
Abortion, Sterilization and Hysterectomy (ASH) Services
Medicare Advantage - New Precertification Requirements Effective September 1, 2015
Medicare Advantage - Part B Drug Reminder
Medicare Advantage - Precertification Required for Hemophilia Drugs
Changes to prior authorization for ear, nose and throat codes​
April 23, 2015, Provider Town Hall Session - West Tennessee
Update to laboratory procedure codes
Medicare Advantage - Recovery Look-Back Period to Align with CMS
My PCP Connection Frequently Asked Questions
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
Encourage Medicare Advantage Members to Stay Up-to-Date on Preventive Care
OrthoNet to conduct post-service prepay reviews
Chiropractic benefits managed by ASH effective June 1, 2015
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
Recoveries related to retroactive eligibility terminations​
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
2015 Town Hall Invites for Middle Tennessee
Medicare Advantage: OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews
New Provider Orientation - Tazewell
New 2015 precertification fax number for skilled nursing, long term acute care and inpatient rehab
December 30, 2014 - Knoxville New Provider Orientation
Medicare Amerivantage PBM Conversion
Upcoming 2014-2015 Provider Orientation Sessions
Attention long-term care (LTC) providers – Please respond to this brief electronic visit verification survey. Participation is mandatory for LTC providers.
Medicare Advantage: Provider Requirements and Medicare Notices
Patient360 Lets You Access Member Records in a Few Clicks​
PCP Rate Increase Decommissioning Bulletin
Amerigroup implementation provider transition FAQs
TennCare Drug Safety Alert to Providers
Nursing Facility Training Invitation
Electronic Visit Verification (EVV) Service Training Invitation
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
Provider NewsBlast – Sept 2014
Upcoming changes to durable medical equipment precertification requirements
Postponed Upcoming Disbursement Process Changes
Provider News Blast Notice - August 2014
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Join Us in the Million Hearts Initiative
Attention Behavioral Health Providers – Please respond to our brief survey to keep us informed of the services your practice currently performs.
Reducing the Overuse of Imaging Studies for Lower Back Pain
Availity Announcement and Frequently Asked Questions
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Coming Soon! Enhanced Online Precertification Tool
Updated CMS 1500 Form
EVV Joint Training with Amerigroup, BlueCare and United
Medicare Advantage Product Highlights Provider Letter
Annual CPG Notice
School Based Services IEP Reminder
Change in Authorization Process for Short Term Nursing Facility Care - CHOICES Group 2 and 3 Members
Putnam County Provider Town Hall Invitation
Provider News Blast - August 2013
New Website Password Requirements
Clarification Regarding Item D Deductions
Medicare Requirements for Outpatient Therapy Claims
August 1 Changes to Precertification Guidelines
Medication Precertification Tool Available Now
The New Electronic Health Risk Assessment Form
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
Consent Form Requirement for Sterilization Services
The Medicare Health Outcomes Survey
Univita Update
Important reminder regarding behavioral health CPT codes
CMS fact sheets about the rate increase for primary care providers
Latest updates on the transition to ICD-10
May 1, 2013, Change to UniCare CPBs & Guidelines
CHOICES critical incident reporting and investigation duties
We launched our newly designed online provider directory in September. Try it out here.
Our Medicaid ID cards have gone mobile!
Preventing the flu
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Provider Self-Service

 Provider Resources & Documents

expand Behavioral Health
Primary Care and Behavioral Health Providers: Working Together to Treat the Whole Person Flier
PACT Level of Care Guidelines Update
I/DD primary care provider survey
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 1
Provider Bulletin 2014, Issue 3
Emergent Diagnosis List
expand Clinical Practice Guidelines
expand Enhanced Personal Health Care Program
Medicare Advantage Medical Panels
Program Overview
expand Forms
BH Outpatient Treatment
Translator Request Form
BH Initial Review Fax Form - Medicaid
BH Concurrent Review Fax Form - Medicare
Advance Directives Information and Form - TennCare (State document)
Psychological Testing Request Form
Recoupment Notification Form
Precertification Request Form
Provider Payment Dispute and Correspondence - Submission Form
Request for level 2 mental health case management services form
expand ICD-10
Medicare ICD-10 Coding Changes
expand Long-Term Services and Supports
CHOICES Critical Incident Reporting and Investigation Details
TennCare QuiLTSS Community Forums for Providers
2014 Maximum ACLF Room and Board Charges
Medial Branch Block Injections
expand Manuals & QRCs
Medicaid Provider Manual
Medicare Quick Reference Card
Member Handbook - Spanish
Member Handbook - Spanish
expand Maternal Child Program
Maternity Care Management Notification
17P Coverage Information​
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters
Provider News: August 2014​
Provider NewsBlast – June 2014
Provider News Blast - September 2014
Provider NewsBlast – December 2014​
Provider NewsBlast - February 2015
Provider NewsBlast – April 2015
2015 Annual NCQA Provider News
Provider NewsBlast - August 2015
Provider NewsBlast - October 2015
Provider NewsBlast - January 2016
Provider NewsBlast - March/April 2016
expand Pharmacy
Medical Injectables Prior Authorization
expand Population Health
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
Quality measures desktop reference for Medicare and Medicaid providers.
expand Quick Tools
Reimbursement Policies
expand Referral Directories
Tennessee Referral Directory
expand State Communications
Rate Reduction letter & Memo (July 3, 2014)
Quality Payments to Nursing Facilities
New Federal HCBS Settings and Person-Centered Planning Rule Consumer and Family Call-In Forums
QuILTSS Questions and Answers
CHOICES Member Reassignment
Health Care Innovation Initiative (3/2015 recorded webinar)​
QuILTSS #5 Bridge Payment Suspension
QuILTSS #6 Bridge Payment Submission
CLS Memo
Keeping TennCare Flyer
ACLF Room and Board Memo
TennCare Pharmacy Program Memo
expand TennCare Kids
TennCare Kids Provider Training
expand TennCare Payment Reform
TENNCARE Bundled Payment Initiative: Description of Bundle Risk Adjustment for Wave 2 Episodes
expand Training Programs
Provider Initiated Notice Presentation
Certification of Mandatory False Claims Act Education Compliance
DSNP Overview Training
Cultural Competency Training
expand Tutorials
Precertification Status and Appeals Tutorial
Provider Updates: Account Information
expand Vendor/Partner Links & Information
TennCare forms for Providers
CareMore Operational Guidelines​
Frequently Asked Questions about PaySpan Health
Centers for Medicaid and Medicare Services (CMS) HCBS Setting Rules Resources

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