Tennessee | Providers – Amerigroup

News & Announcements

Elective one and two vessel coronary artery bypass graft to require prior authorization
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
Physicians: 12/31/16 enrollment deadline for PIPP
Hospitals: 12/31/16 enrollment deadline for PIPP
Physicians: Update to MU requirements for PIPP
Hospitals: Update to MU requirements for PIPP
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
Effective September 15, 2016: Level II Case Management will only require notification
Medicare Advantage - Prior Authorization Requirements for Inflectra and Cinqair
Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
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
Change to inpatient diagnosis-related group claim submission requirements related to itemized billing
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
Federal nondiscrimination and accessibility update
Medicare Advantage - Prior Authorization for Emend (Fosaprepitant), Aloxi (Palonosetron), and Afstyla (Antihemophilic)
Update: Certain drugs to require prior authorization
Authorizations and medical necessity reminder
Medicare Advantage - Prior Authorization Requirements for Vascular Embolization or Occlusion Services
ClaimsXten Upgrade
Medicare Advantage - Care Program Available for Medicare Advantage Members Facing Advance Illness
Medicare Advantage - Dual Advantage Simple Billing Tips
Precertification for knee and spine orthoses effective July 1, 2016
Medical injectable access via ProCare Pharmacy Direct (CVS Specialty subsidiary)
Tennessee Health Link program
Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
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
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 Resources & Documents

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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
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CHOICES Critical Incident Investigation Report Form
CHOICES Critical Incident Report Form
TennCare QuiLTSS Community Forums for Consumers
TennCare Budget Reduction Memo
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Provider Facility ED Policy
Provider Bulletin 2014, Issue 2
Electronic Data Interchange (EDI)
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2016 Clinical Practice Guideline Matrix
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Employment Services Staff Qualifications (external document)
ECF CHOICES Employment Provider Training
Overview of Critical Incident Management in Employment and Community First CHOICES
Employment and Community First CHOICES employment provider FAQ
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Measurement Period Handbook
Program Description for the EPHC
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Refund Notification Form
BH Initial Review Fax Form - Medicare
BH Concurrent Review Fax Form - Medicaid
Provider Referral Form – Memphis (CareMore)
Makena Pharmacy Referral Form
IEP Request Form
Provider Initiated Notice - Adverse Action Form
Primary Care Provider Change Form
Skilled nursing facility/rehabilitation precertification worksheet
Out-of-Network Precertification Request Form
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CHOICES Provider Manual Supplement
Quick Reference Card
Member Handbook
Medicare Provider Manual
Employment and Community First CHOICES Provider Manual Supplement
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Maternity Care Management Notification
17P Coverage Information​
Maternity Care Management Notification Form
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Health Education and Wellness
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Provider News Issue 1 2014
Provider NewsBlast – May 2014
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Provider News Blast - October/November 2014
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Natn'l Drug Code FAQs
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About Population Health
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Quality measures desktop reference for Medicare and Medicaid providers.
expand Quick Tools
Reimbursement Policies
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Tennessee Referral Directory
TN Employment and Community First CHOICES
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Rate Reduction Memo (July 22, 2014)
QuILTSS #4 Bridge Payment Submission
QuILTSS Nursing Facility Value-Based Purchasing Quality Framework
TennCare Synagis Season 2014-2015 Information​
2015 Maximum Room and Board Charges for ALF
Preferred Drug List eff 6-1-15
Budget Reductions/Impacts for July 1, 2015
QuILTSS Bridge Payment for Nursing Facilities - Staff Roster
Appropriate Use of Psychotropic Medications for People with IDD
Keeping TennCare Flyer (Spanish)
TennCare Pharmacy Program Update
TennCare Pharmacy Program Update
ECF Discovery Service - Recommended Steps and Timeframes
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TennCare Kids Provider Training
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TENNCARE Bundled Payment Initiative: Description of Bundle Risk Adjustment for Wave 2 Episodes
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Provider Initiated Notice Presentation
Certification of Mandatory False Claims Act Education Compliance
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Medication Precertification Tutorial
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AIM (Diagnostic and Imaging Service Authorizations)
Express Scripts Provider Portal - Medicare
TennCare Home- and Community-Based Service (HCBS) Setting Resources
American Academy of Pediatrics EPSDT and Preventive Services Manual

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