Texas | Providers – Amerigroup
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News & Announcements

March 2019 Clinical Utilization Management Guidelines
Drug Screen Testing Update
MMP Drug Screen Testing Update
Clinical Criteria Web Posting July 2019
MMP Medical Policies and Clinical UM Guidelines update
Medicare Advantage - 2019 Risk Adjustment Provider Trainings
March 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Pharmacy benefit manager change to IngenioRx
June 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Prior authorization requirements changes effective November 1, 2019
MMP Clinical Criteria Web Posting Q2 2019
MMP Clinical Criteria Updates
MMP Clinical Criteria Web Posting Q1 2019
Authorizations related to Long-Term Services and Supports Billing Matrix updates
Assisting your patients in managing the Donut Hole
Lowering health risks with no-cost statins
Prior authorization requirements for continuous positive airway pressure supplies
MMP Changes to PA requirements
Medicare Advantage – January 2019 Medical Policies and Clinical Utilization Management Guidelines update
EVV provider webinar training schedule
Medicare Advantage – March 2019 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – CLIA for Amerigroup
Medicare Advantage – Pharmacy benefit manager change to IngenioRx
Clinical Criteria Web Posting Q1 2019
STAR+PLUS long-term services and supports provider update
Clinical Laboratory Improvement Amendments
Semi-Annual Cost of Care Review
Medicare Advantage- AGP Customization for IP Cancer Therapy
Customization for IP Cancer Therapy
Evaluation and management services -over-coded services
Texas Medicare: IntegraNet, Gonzaba, Prospect and Great States Health independent physician association collaboration
Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy
MMP - Hearing Care Solutions began service June 6, 2019
Clinical Criteria Web Posting Q2 2019
Medicare Advantage – Clinical Criteria Web Posting Q2 2019
Beacon Health Options
January 2019 Medical Policies and Clinical Utilization Management Guidelines Update
OBGYN Ultrasound Update
Behavioral health prior authorization reminder regarding ambulatory and residential detoxification
Unspecified Diagnosis Code Update
Case Management Referral Form
Deactivated NCCI MUE Limitations for Substance Use Disorder Treatment and Breast Pump Replacement Parts
Prepayment clinical validation review process
Upgrade to 23rd Edition of MCG Care Guidelines
MMP Prior authorization requirements for Part B drug Evomela
Span of coverage information
Updated Limitation for Zika Virus Testing Effective July 1, 2019
Delegated Psychological Services to Allow More Than One Modifier on the Same Date of Service Effective July 1, 2019
Tobacco Use Cessation Services Provided in a Group Setting
Update to Emergency Department: Level of E&M Services Reimbursement Policy (Medicare-Advantage Only)
Medicare Advantage – Outpatient Rehabilitation Program transitioning to AIM
MMP Outpatient Rehabilitation Program transitioning to AIM
2019 Texas Pay for Quality Provider Incentive Plan
MMP Submitting corrected claims
MMP Partial hospitalization services
Medicare Advantage – Medical records request for risk adjustment
Update: Medicare Advantage – 2019 risk adjustment provider trainings
Update: Medicare Advantage – Submitting corrected claims
MMP Medical records request for risk adjustment
2019 Utilization Management Affirmative Statement concerning utilization management decisions
MMP-2019 Utilization Management Affirmative Statement concerning utilization management decisions
Medicare Advantage – Fall prevention tips
Smoking and Tobacco Use Cessation Counseling Benefits to Change for Texas Medicaid on May 1, 2019
Medicare Advantage – AIM cardiology and radiation oncology guidelines
Prior authorization update for physician order requirements
Sports physicals and annual checkups
Medicare Advantage – Prior authorization requirements for DME repair and portable oxygen concentrator
MMP Prior authorization requirements for DME repair and portable oxygen concentrator
Revision to Facility Emergency Department reimbursement policy postponed
Medicare Advantage – Medical Policies and Clinical Utilization Management Guidelines update
MMP Update: evaluation and management with Modifier 25
November 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage - Update: 2019 Risk Adjustment provider trainings
Alert - EVV Tool Kit Module Two
Module Two - EVV Roles and Responsibilities Part 1 of 2
Clinical Criteria updates
Medicare Advantage – Pharmacy and Therapeutic Committee updates
Changes to outpatient BH PA requirements
Wound care treatment request update
Guidelines for communications between providers
MMP - New specialty Medicare Part B device Voluntary Steerage Program
Medical necessity review for appropriate level of care
Enhanced claim payment dispute process
Medicare Advantage – Member Explanation of Benefits redesigned
Medicare Advantage – New specialty Part B device Voluntary Steerage program
Medicare Advantage – 2019 Risk Adjustment Training
Quarterly pharmacy formulary change notice effective October 1, 2018
September 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage – Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – New provider learning opportunity: Put the ProviderPortal to work for you
Medicare Advantage – New provider service phone number beginning January 1, 2019
Medicare Advantage - CMS Preclusion List effective April 1, 2019
Medicare Advantage - When and how to initiate reopenings
Medicare Advantage - Plans to move compound drugs off formulary beginning January 1, 2019
Medicare Advantage - Part B drugs may include Step Therapy beginning January 1, 2019
Electronic data interchange gateway update
July 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Therapy services monitoring
Medicare Advantage – 2019 Annual Notice of Change
Prior authorization requirements for Sublocade
Alert - Texas Credentialing Alliance & CVO Reminder about CVO Process & Availity Portal
Prior authorization requirements for Subcutaneous Implantable Defibrillator system
MMP Transition of back pain management and cardiology utilization management programs from OrthoNet to AIM
Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
Online registration processes for electronic remittance advices and electronic funds transfers
Effective September 1, 2018, Amerigroup has transitioned into a strategic relationship with Availity
Accessing Remittance Inquiry
Remittance Inquiry Tool Now Available
Alert - Texas Credentialing Verification Organization
Guidelines update for processing therapy precertification requests
Medicare Advantage – Genetic testing prior authorization by ordering physician helps ensure accurate lab payment
Medicare Advantage – Amerigroup transitions back pain management and cardiology UM programs from OrthoNet to AIM
Medicare Advantage – Please evaluate statin use for MA members with diabetes, cardiovascular disease
Medicare Advantage – Medicare pharmacy and prescriber home starts January 2019
TX MMP Prior authorization requirements for Part B drug Nivestym
Medicare Advantage – Prior authorization requirements for Part B drugs: Nivestym
MMP Prior authorization requirements for high-level, definitive drug
New pharmacy electronic prior authorization request tool (ePA) through CoverMyMeds
Neonatal Level of Care Designation Required
Prior authorization requirements for high-level, definitive drug testing
New pharmacy prior authorization retail fax number
TX MMP Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila
Prior authorization requirements for Interferon beta-1a
Prior authorization requirements for Somatrem
MMP Inpatient Readmissions reimbursement policy update
Medicare Advantage – myNEXUS Home Health Care Program for Utilization Management, Network Contracting and Claims Processing FAQ
Medicare Advantage – Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila
Neonatal Level of Care Designation Required for Hospital Providers Rendering Neonatal Inpatient Services
Medicare Advantage CMS issues regulatory changes for short- and long-acting narcotics; days’ supply limits effective Jan. 1, 2019
Medicare Advantage – DME providers and physicians: important wheelchair prior authorization information
Medicare Advantage – Submit PA medication requests electronically; new phone number for MA prescription Pas effective Sept. 1
Medicare Advantage – Members receive incentives for completing screenings
Medicare Advantage – Amerigroup adopts Milliman Care Guidelines for inpatient rehabilitation, subacute rehabilitation and skilled nursing facility clinical reviews
May 2018 Medical Policies and Clinical Utilization Management Guidelines Update
MMP Prior authorization requirements for Azedra and Poteligeo
January 2018 Medical Policies and Clinical Utilization Management Guidelines Updates
March 2018 Medical Policies and Clinical Utilization Management Guidelines Updates
MMP Prior authorization requirements for Part B drugs: Retacrit, Damoctocog and Ilumya
Medicare Advantage – Inpatient Readmissions Medicare Advantage Update
Medicare Advantage – Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – Prior authorization requirements for Part B drugs Retacrit, Damoctocog and Ilumya
Amerigroup opioid analgesics utilization management clinical policies
Medicare Advantage – MyDiversePatients.com
Prenatal and postpartum outreach initiatives
Non-emergency ambulance prior authorization update
Medicare Advantage – Medical Policies Update
Prior authorization requirements for Cabazitaxel
Postpartum placement of long-acting reversible contraception
Medicare Advantage – Prior authorization requirements for Part B drugs: Azedra and Poteligeo
MMP Prenatal and postpartum outreach initiatives
Medicare Advantage – Peer-to-Peer Process
Medicare Advantage – Home Health network to be delegated to myNEXUS
Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)
MMP Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
Services requiring prior authorization
Lower extremity vascular intervention codes require prior authorization
MMP Prior authorization requirement for Part B drug: Trelstar
Prior authorization requirements for Darzalex drug
Medicare Advantage – Improve Medicare Advantage Members’ Medication Adherence with 90-day Prescriptions
CHIP copay changes
MMP Prior authorization requirements for cardiovascular services
Medicare Advantage – Cologuard covered for Medicare Advantage members
Electrical stimulation device to require prior authorization
MMP Electrical stimulation device to require prior authorization
Medicare Advantage – Prior authorization requirements for Cardiovascular Services
MMP Prior authorization requirements for Part B drugs: ZEVALIN and Eptacog
Medicare Advantage – CMS Selects Amerigroup for 2016 National RADV Audit
Medicare Advantage – Prior authorization requirement for Electrical Stimulation Device
Medicare Advantage – Prior authorization requirements for part B drugs: Zevalin and Eptacog
Medicare Advantage – Prior authorization requirements for part B drug: Trelstar
MMP New Original Medicare ID Cards on the Way
New Texas Credentialing Verification Organization coming April 1, 2018
New Texas Credentialing Verification Organization coming April 1, 2018 for Amerigroup STAR+PLUS MMP
Prior authorization requirement update for Mylotarg
Medicare Advantage – myNexus Network Contracting FAQ
Q4 Medical Policies and Clinical Utilization Management Guidelines Updates
Medicare Advantage – Utilization management decisions based on appropriateness of care, benefits
Medicare Advantage – Prior authorization requirements for CAR-T Therapy
Medicare Advantage – Amerigroup to conduct post-payment reviews of distinct procedural services modifiers
MMP Prior authorization requirements for Part B drugs: Mylotarg and Mvasi
MMP Prior Authorization for: Brineura, Tremfya and Zinplava
AIM Musculoskeletal Guidelines Notice
MMP 2018 Utilization Management Affirmative Statement
HHSC Credentialing Verification Organization (CVO) Provider FAQ
HHSC Credentialing Verification Organization (CVO) Provider Notification Scheduled Webinar
HHSC Credentialing Verification Organization (CVO) Provider Notification
STAR Kids Clinical and Administrative Advisory Committees
TAHP Credentialing Verification Organization Information
Medicare Advantage – Prior authorization requirements for part B drugs: Mylotarg and Mvasi
Medical Policy update - Hyaluronan Injections
2018 Utilization Management Affirmative Statement
Eight injectable drugs will require prior authorization
MMP Prior Authorization for: Varubi and Fasenra
Medicare Advantage – Medical Policies and Clinical Guidelines updated
Medicare Advantage – Improve member medication regimen
MMP Prior Authorization for: Rebinyn, Fibryna and Hemlibra
Overpayment identification and refund requirements
Elotuzumab to require prior authorization
Medicare Advantage – Prior authorization requirements for injectable drugs: Brineura, Tremfya and Zinplava
Medicare Advantage – Prior authorization requirements for Part B drugs: Rebinyn, Fibryna and Hemlibra
Medicare Advantage – Imaging Services Providers Must Complete OptiNet Assessments to Avoid Line-item Denials
Medicare Advantage – Prior authorization requirements for part B drugs Varubi and Fasenra
Q3 Medical Policies and Clinical Utilization Management Guidelines Updates
Update to precertification requirements for radiation oncology, sleep medicine and cardiology services
Consolidated Credentialing Verification Organization (CVO) Initiative
Credentialing Verification Organization (CVO) Provider FAQ
Medicare Advantage – 2018 Annual Visit Guidelines
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
New prior authorization requirements for clinician-administered drugs Exondys and Kymariah
MMP New pharmacy prior authorization fax number effective January 1, 2018
MMP New medication electronic prior authorization request tool effective January 1, 2018
MMP Prior authorization requirements for Part B drugs Besponsa and Vyxeos
Medicare Advantage – Amerigroup to conduct post-service reviews of certain modifiers and services
Medicare Advantage – New Original Medicare ID Cards on the Way
Medicare Advantage – Amerigroup tiers SNF network
Medicare Advantage – Change to the ERA for all who are enrolled in a Special Needs Plan
Medicare Advantage – Change to the ERA for all who are enrolled in a Special Needs Plan
Medicare Advantage – Additional hypertension drugs available at $0 copay
Medicare Advantage – 2018 Annual Notice of Change
Medicare Advantage – Prior authorization requirements for Part B: Aliqopa, Cinvanti and Opsiria
Moving Towards Equity in Asthma Care- Continuing Medical Education Credit Opportunity
New Medicaid member appeals process changes effective September 1, 2017
Medicare Advantage – Prior authorization requirements for part B drugs: Besponsa and Vyxeos
MMP Prior Authorization requirements for Part B Drugs Aliqopa, Cinvanti, and Opsiria
Required prior authorization for genetic testing effective December 15, 2017
Medicare Advantage – Coordination of Benefits Update
Medicare Advantage – Members Should Use NationsHearing
Medicare Advantage – Network Delegation for Home Health Care Services
Medicare Advantage – Critical Access Hospitals (CAH) Reimbursed at Medicare Rate
Medicare Advantage – Include NPI on Surgical Procedure UB04 Bills
Medicare Advantage – Members to Receive Gift Cards Diabetic Retinal Eye Exams
Medicare Advantage – Help Ensure Medicare Part D Members Receive a Comprehensive Medication Review
Medicare Advantage – Complete OptiNet Assessments for Out-of-State Office Locations; Drop Down Menu Changed
Medicare Advantage – Prior Authorization for part B drugs Renflexis, Rituxan Hyclea, and Zilretta
EVV and Hurricane Harvey
EVV FAQs Hurricane Harvey
Updated Medicaid/CHIP Provider Manual
New review process for not otherwise classified drug codes
MMP Prior authorization requirements for Part B drugs: Renflexis (infliximab-abda),Rituxan Hyclea (rituximab/hyaluronidase) and Zilretta (triamcinolone acetonide SR)
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Include National Provider Identifier on surgical procedure UB04 bills-MMP
Register Now for EVV Provider Stakeholder Meetings
Medicare Advantage – Prior Authorization Requirement Change for Orthotics
Update to ordering/prescribing/referring claim submissions
Clinician administered drug requirements for RhoGam
Private Duty Nursing versus Skilled Nursing PCP Toolkit
STAR Kids LTSS Provider Update
Emergency Prescription Guidelines for Schedule II Medications
Orthotics to require prior authorization
Medicare Advantage – Noncovered Services FAQs
New therapy prior authorization request form
Q2 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – Prior Authorization for Genetic Testing for Members Effective Nov. 1
Attendant Compensation Enhancement Program open enrollment
AAPCA and MBCC programs managed care expansions
El Paso Children’s Hospital announcement
MMP Prior authorization requirements for Part B drug: Imfinzi (durvalumab)
MMP Prior authorization requirements for Part B drug: Yondelis (trabectedin)
Medicare Advantage – Prior authorization requirement change for part B drug Yondelis
THSteps Therapeutic Dental Benefits to Change for Texas Medicaid July 1, 2017
Medicare Advantage – Prior authorization requirement change for part B drug Imfinzi
STAR+PLUS long-term services and supports update
Hemophilia factor injections to require prior authorization
Medicare Advantage - Modifier FX and Reimbursement Policy Update
MMP - Modifier FX and Reimbursement Policy Update
CHIP Providers Must Complete Enrollment by December 31, 2017
Medicare Advantage - Submitting Corrected Claims
Medicare Advantage - Bill CLIA Certification for Claims
Medicare Advantage - HCPC Codes Allow for Payment for Coordinating Behavioral Health Services
Medicare Advantage - MRP Billing Codes for Reimbursement
Medicare Advantage - Imaging Services Providers Must Complete OptiNet Assessments to Avoid Line-item Denial
Medicare Advantage - Access Patient360 for your patient records directly through the Availity Web Portal
Wheelchair component or accessory, not otherwise specified to require prior authorization
Q1 Medical Policies and Clinical Utilization Management Guidelines update
Update regarding appointment availability standards
Radiation oncology, sleep medicine and cardiology services for STAR and STAR+PLUS members 21 and older
MMP Prior authorization requirements for Part B drug: Bavencio (avelumab)
MMP Prior authorization requirements for Part B drug: Herceptin (trastuzumab)
MMP Prior authorization requirements for Part B drug: Spinraza (nusinersen)
Medicare Advantage - Prior authorization requirement change for part B drug: Bavencio
Medicare Advantage - Prior authorization requirement change for part B drug: Herceptin
Medicare Advantage - Prior authorization requirement change for part B drug: Spinraza
MMP Prior authorization requirements for the Part B injectable/infusible drug Exondys 51 (eteplirsen)
Spinraza Prior Authorization and Billing Requirements
Miscellaneous wheelchair code precertification update
MMP Update to the ClaimsCheck® upgrade to ClaimsXten™
Appointment Availability and After-Hours Access Requirements
Medicare Advantage - Inpatient Readmissions Update
MMP - Inpatient Readmissions Update
Pain Management Request Update
Medicare Advantage - Amerivantage ESRD (HMO-POS SNP) offers benefits designed for ESRD patients
Medicare Advantage - Prior Authorization requirements for Continuous Interstitial Glucose Monitoring
MMP High-Risk Medication Report
MMP Prior authorization required for continuous interstitial glucose monitoring
Medicare Advantage - AccordantCare™ to provide support for members with HIV
Medicare Advantage - New Coding Guidelines for 3D Mammography
Medicare Advantage - Coding Patient Services Reminders
Medicare Advantage - Comply with Clinical Information Requests
Medicare Advantage - New G Codes for Home Health Agencies
Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
Medicare Advantage - New Place of Service Code 02 for Telehealth Services
Medicare Advantage - Preventive Service Procedure Codes updated for 2017
Medicare Advantage - Review High-Risk Medication Reports
Medicare Advantage - CMS Selects Amerigroup for 2015 National RADV Audit
Medicare Advantage - Prior Authorization Requirements for Part B Drug - Exondys 51
Medicare Advantage - Prior Authorization Requirements for Part B Drug - Evomela
Medicare Advantage – AIM OptiNet Registration FAQ
NEMT Form Update
Level two and level three shower chairs to require prior authorization
Medicare Advantage - Complete your AIM OptiNet® registration services by April 1, 2017
Universal billing claim requirement clarification
MMP Epidermal Growth Factor Receptor Testing with the attached
Part B Drug Evomela MMP Green
Medicare Advantage - CMS Emergency Preparedness Rule
Behavioral Health Authorization Clarifications
MMP Behavioral Health Authorization Clarifications
Medicare Advantage - HEDIS Measure: Ensure Medication Reconciliation is Completed after Discharge
MMP Additional information on ClaimCheck®* upgrade to ClaimsXten™*
Medicare Advantage - Behavioral Health Authorization Clarifications
Amerigroup Texas Fee Schedule
Medicare Advantage - Radiation Therapy Services – Contact AIM for Delivery, Amerigroup for Planning
Medicare Advantage - Transitional Care Management (TCM) Services
Medicare Additional information on ClaimCheck® upgrade to ClaimsXten™
Medicare Advantage - Retrospective Medical Record Review Program Launches
Medicare Advantage - Members Should Use Hearing Care Solutions
Medicare Advantage - Claims for Tetanus Vaccinations
Medicare Advantage - Payment Reduction for X-rays Taken Using Film
Genetic testing services to require prior authorization
Additional information on ClaimCheck® upgrade to ClaimsXten™
MMP Epidermal Growth Factor Receptor Testing
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Clarification on medical director peer-to-peer process
MMP AIM Radiation Oncology Program
Medicare Advantage - Additional Information on ClaimCheck Upgrade to ClaimsXten
Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
Notification process reminder
Miscellaneous durable medical equipment billing guidelines
Hospital observation service limits MMP
Medicare Advantage - Prior Authorization Requirement Change to Epidermal Growth Factor Receptor Testing
Medicare Hospital observation service limits
Medicare Advantage - Hospitals must use Medicare Outpatient Observation Notice
MMP Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Medicare Advantage - myNEXUS Clarification for TX
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Medicare Advantage – 2017 Annual Notice of Change
Continuous interstitial glucose monitoring to require prior authorization
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Medicare Advantage – Transitional Care Management Services Eligibility
Medicare Advantage – Verify Injectable, Infusion Billable Units Approved via AIM
Medicare Advantage - Routine Physical Exams are Covered in 2017
Medicare Advantage – DSNP Provider Training
Medicare Advantage – AIM Clinical Appropriateness Guidelines for Advanced Imaging
Medicare Advantage - Attend December Webinar/Webinars to Learn how to Complete OptiNet Assessments
Medicare Advantage - DEN Program Helps Members Better Manage Diabetes
Medicare Advantage - Cardioverter Defibrillators : Confirm if Authorization Required for Implants
Medicare Advantage – Avoid Needless Claims Denials with These Tips
Medicare Advantage - 2017 Benefits and Formularies Available
MMP Continuous interstitial glucose monitoring to require prior authorization
MMP New Injectable Infusible Drugs: Erelzi (etanercept), Amjevita (adalimumab), Voretigene neparvovec, Nanacog (recombinant factor IX) and Lartruvo (olaratumab)
MMP New Injectable Infusible Drugs: Cuvitru, Ocrevus and Lutathera
Medicare Advantage - Prior Authorization Requirements for Cuvitru, Ocrevus and Lutathera
Medicare Advantage - Prior Authorization Requirements for Intracardiac Electrophysiological Studies and Catheter Ablation
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage - Prior Authorization Requirements for Erelzi, Amjevita, Voretigene neparvovec, Nanacog and Lartruvo
Medicare Advantage - Risk Adjustment and Documentation Guidance Training Offered
Medicare Advantage - 2017 Coverage Changes for Diabetic Supplies
MMP Prior authorization requirement change for Torisel® (temsirolimus)
2016 Medicare Clinical Practice Guideline Matrix
Prior authorization requirements for new injectable/infusible drugs: Darzalex (daratumumab) and Empliciti (elotuzumab)
Medicare Advantage - Clarification for Requesting Authorization for certain Arterial Duplex Imaging Procedures
Medicare Advantage - Prior Authorization Requirements for Continuous Interstitial Glucose Monitoring
MMP Elective one and two vessel coronary artery bypass graft to require prior authorization
Elective one and two vessel coronary artery bypass graft to require prior authorization
MMP New Injectable Infusible Drugs: interferon gamma-1b (Actimmune®), mecasermin (Increlex®) and azacitidine (Vidaza®)
MMP New Injectable Infusible Drugs: Doxil (doxorubicin) and Sustol (granisetron)
Patient Protection and Affordable Care Act Deadline has Passed
Clarification of Arterial Codes 10 Day Rule
Patient Protection and Affordable Care Act Deadline has Passed
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
MMP Prior authorization requirements for new injectable/infusible drugs: Inflectra (infliximab-dyyb) and Cinqair (reslizumab)
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
MMP New Injectable Infusible Drugs - Emend (fosaprepitant), Aloxi (palonosetron) and Afstyla (antihemophilic)
Medicare Advantage - Complete your Medicare Advantage AIM OptiNet® registration by Jan. 1, 2017
Medicare Advantage - Recommended Skilled Nursing Providers
Medicare Advantage – Prior Auth for New Injectable/Infusible: Tecentriq
Medicare Advantage – Prior Auth for Elective One and Two CABG
Medicare Advantage - Prior Authorization Requirements for Inflectra and Cinqair
2016 Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
MMP New Injectable Infusible Drugs Istodax, Ixempre and Taltz
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
Medicare Advantage - Complete Your Medicare Advantage AIM OptiNet Registration for X-ray, Ultrasound or High-Tech Imaging Services
Medicare Advantage - Alendronate added to the $0 Copay Tier
Medicare Advantage - Improve Member’s Medication Adherence with 90-Day Prescriptions
Medicare Advantage - Clinical Cumulative Morphine Equivalent Dosing Point of Sale Edit effective January 1, 2017
Medicare Advantage - Assisting Members with Rheumatoid Arthritis Who May Be Missing Important Medications
Medicare Advantage - In-Home Bone Mineral Density Testing
Medicare Advantage – In Home Visits Available for Members with Chronic and Complex Conditions
Medicare Advantage - Care Program Available for Members Facing Advanced Illness
Medicare Advantage - AIM Clinical Appropriateness Guidelines for Advanced Imaging effective November 1, 2016
Medicare Advantage - Prior Authorization for Emend (Fosaprepitant), Aloxi (Palonosetron), and Afstyla (Antihemophilic)
Effective November 1, 2016 ClaimsCheck® upgrade to ClaimsXten™
Precertification update for vascular embolization or occlusion services
Medicare Advantage - Member Incentive for Annual Routine Physical
Medicare Advantage - Prior Authorization Requirements for Vascular Embolization or Occlusion Services
MMP - Precertification update for vascular embolization or occlusion services
Precertification requirements for knee and spinal orthoses
Texas Medicaid Re-Enrollment Reminder
Postpartum long-acting, reversible contraception benefit now available
Primary care provider change form now available
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Medicare Advantage - Dual Advantage Simple Billing Tips
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Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
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
Precertification for knee and spine orthoses effective July 1, 2016
Medicare Advantage - Inpatient Stays and Observation : Please Help Members Maximize Health Benefit
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
Update on Pharmacy Prior Authorization Submissions
Medicare Advantage-AIM Oncology and Oncology Drugs
Medical policies update
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 - CMS Selects Amerigroup for 2014 National RADV Audit
Medicare Advantage - Quarterly Update to the Medicare Physician Fee Schedule
Medicare Advantage - AIM OptiNet imaging provider registration Frequently Asked Questions
Medicare Advantage - Additional Radiation Oncology Prior Authorizations Should Be Directed to AIM Effective July 1, 2016
Medicare Advantage - UPDATED: Imaging Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage - New Prior Authorization Requirements Effective May 1, 2016
Medicare Advantage - Member Incentive for Wellness Visit
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage - UPDATE: Contact AIM for Outpatient Radiation Oncology Prior Authorization
Precertification for knee arthroscopy effective April 1, 2016
Precertification for knee and hip arthroplasty effective May 1, 2016
Custom molded orthotics precertification
Medicare Advantage – SELECT product
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
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
Medicare Advantage - Radiation Therapy: Select Brachytherapy, IMRT CPT Codes to Require Prior Authorization
Medicare Advantage - Avoid Denials of Diagnostic Claims by Completing Item 20 (CMS 1500) Correctly
Medicare Advantage - Providers Must Enroll with Medicare to Prescribe Part D
Medicare Advantage - Amerigroup Encourages High-Risk Members to get a Flu Shot
MMP: Addition to Part B injectibles/infusibles effective January 1, 2016
Medicare Advantage - 2016 Plan Changes
Medicare Advantage - Diabetic Supply Changes for 2016
Medicare Advantage - Routine Physicals for 2016
Hemophilia Drugs Authorization Update Effective December 15, 2015
Prior authorization required for drugs Entyvio and Cyramza
Medicare Advantage - Imaging Site Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage - New 2016 prior authorization requirements effective January 1, 2016
Home Health Therapy Codes Update Effective November 15, 2015
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage - Part B Updates for Praluent, Repatha and Sylvant
MMP: Behavioral Health: Authorization Changes Effective October 1, 2015
Medicare Advantage - Precertification update for scoliosis and spine deformity
Behavioral Health: Authorization Requirement Changes Effective October 1, 2015
Cervical Length Screening Guidelines
Precertification for Part B Drugs Entyvio and Cyramza
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
Medicare Advantage - DSNP Training Invite
Medicare Advantage - 2015 Specialty Rx Plan Changes to Claims Payment
Medicare Advantage - New Precertification Requirements Effective September 1, 2015
DME Provider Orientation Webinar Schedule and Invite​
Amerigroup Changes PBM to Express Scripts Starting June 1
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
Reminder: Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) is live!
Medicare Advantage - Part B Drug Reminder
Medicare Advantage - Precertification Required for Hemophilia Drugs
Medicare Advantage - Recovery Look-Back Period to Align with CMS
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
Medicare Advantage - 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
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
Medicare Advantage: OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews
New 2015 Medicare Advantage precertification fax number for skilled nursing, long term acute care and inpatient rehab
Medicare Amerivantage PBM Conversion
Medicare Advantage: Provider Requirements and Medicare Notices
Medicare Advantage 2015 Annual Notice of Change in Products
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
Flu Vaccinations
Service Area Change Fax
Medicare Advantage Peer to Peer Changes
Inpatient Readmissions
Encourage Exercise to Prevent Falls
Postponed: Upcoming Disbursement Process Changes
Now Available Online: Updated Medicaid/CHIP Provider Manual
Upcoming changes to durable medical equipment precertification requirements
Availity Announcement and Frequently Asked Questions
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Bone Density Testing for Medicare Members
Medicare Advantage Members to Receive Monthly Summary Statements
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Updated CMS 1500 Form
El Paso Lubbock Medicare Advantage Product Highlights Provider Letter
Dallas Ft. Worth Medicare Advantage Product Highlights Provider Letter
San Antonio Medicare Advantage Product Highlights Provider Letter
Houston Medicare Advantage Product Highlights Provider Letter
Medicare Requirements for Outpatient Therapy Claims
Medication Precertification Tool Available Now
The New Electronic Health Risk Assessment Form
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
Precertification Appeals Tool Coming Soon
Online Claims Appeal Tool Coming Soon
The Medicare Health Outcomes Survey
CMS fact sheets about the rate increase for primary care providers
Assess and strengthen your cultural competency
Our Medicaid ID cards have gone mobile!
We launched our newly designed online provider directory in September. Try it here.

Hurricane Harvey: CHIPS copayment notice

Hurricane Harvey: Disability Resources

Hurricane Harvey – DSHS Lab Specimens

Louisiana Providers Servicing TX Medicaid-CHIP Members

Waivers of Regulatory Requirements for Weather-Impacted Long-Term Care Providers

If Affected by Hurricane Harvey Use EVV Reason Code 130

Hurricane Harvey Regulatory Updates

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HHSC EVV Reason Code List - Effective 7/1/2017
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Electronic Visit Verification (EVV) Roadshow: Amerigroup
October 2017 HHSC EVV Reason Code Scenarios
Electronic Visit Verification(EVV)Provider Stakeholder Meeting
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Small Alternative Device Zip Tie Policy Change
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Visit Maintenance Reduction Solutions
MEDsys Providers – Key Dates, Transition Instructions and Frequently Asked Questions
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Electronic Visit Verification Providers Transitioning to Datalogic
Reminder to EVV Providers Transitioning to DataLogic
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Providers billing for long-term services and supports required to use electronic visit verification
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HHSC Provided EVV Toolkit
HHSC Electronic Visit Verification -EVV 101 Introduction to EVV Presentation
Alert - EVV Tool Kit Module Two
EVV Visit Maintenance of MEDsys EVV Historical Data
EVV Tool Kit – Module Three: EVV Roles and Responsibilities
EVV Updated Billing Policy Requirements
Module 4 EVV Visit Transactions
EV Mobile Application Available
New EVV Provider Data Validation Process
HHSC Electronic Visit Verification Module 7
EVV Tool Kit Module 8: Submitting an EVV Claim
HHSC Notice: Provider EVV Claim Submission to TMHP
Changes to EVV Vendor System Effective 06.01.19
EVV Tool Kit Module 10: EVV Visit Transaction Validation Enhancements
Amerigroup Provider Update: EVV Claim Submission
HHSC Visit Maintenance Unlock Request Policy
TMHP EVV Webinar Training
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HHSC EVV Training Schedule
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EVV Reason Code and Required Free Text Policy
EVV Training Policy
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EVV Visit Maintenance Unlock Request Policy-Revised
HHSC Request Approval from CMS to Delay EVV Start Date for PCS
TMHP Technical Information for Claim Submission
HHSC Updates to STAR+PLUS LTSS Billing Matrix and Authorizations
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Texas Standard Prior Authorization Request
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PCP Change Request Form (Spanish)
Texas Individual Allied Health Professional Application and Information Release Form
Practitioner Employment Assistance\Supported Employment Application
Neuropsychological Testing Request Form MMP
Neuropsychological Testing Request Form Medicare
Payment Dispute and Correspondence
Non-emergency Ambulance Exception Form
Behavioral Health Psychological Testing Request for Authorization Form
BH Initial Review Fax Form - Medicare
BH Initial Review Fax Form - Medicare
BH Outpatient Treatment - Medicare
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Medicare Advantage Medical Record Documentation & Coding Tips
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Medicare Provider Manual
Breast Pump Coverage in Medicaid and CHIP
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Program Overview
Healthy Rewards Flier
Makena Prior Authorization Form
Provider FAQ — Availity Web Portal pregnancy notification and HEDIS attestation
Coding Spotlight — Pregnancy
OBGYN Ultrasound Update
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Health Education and Wellness
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Provider News Issue 1 2016
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2017 Quarter 1 Provider Newsletter
2017 Quarter 3 Provider Newsletter
February 2018 Provider Newsletter
June 2018 Provider Newsletter
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October 2018 Provider Newsletter
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June 2019 Provider Newsletter
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Pharmacy Tools
Synagis Enrollment Form
Texas Vendor Drug Program Clinical Edits
Pharmacy Prior Authorization Forms
2019 Mosquito Repellent Standing Order
Pharmacy Prior Authorization Presentation
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HEDIS Desktop Reference Guide for Medicaid Providers
Moving Towards Equity in Asthma Care- Continuing Medical Education Credit Opportunity
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Texas Provider Rep contact list
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Dual Eligibles Integrated Care Demonstration Project FAQs
BH Concurrent Review Form
BH Discharge Note
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Amerigroup STAR+PLUS Medicare-Medicaid Plan (MMP) Provider Manual
Medical necessity review by AIM for oncology
Clinical Practice Guidelines Matrix - MMP
MMP Retail Prior Authorization Form
expand State Communications
Notice to Prescribers: Mosquito Repellent Benefit
THSteps Clinical Record Review Tool
Texas Health Steps Regional Provider Representatives
HHSC Notice - MDCP Loss of Eligibility
Mental Health Screenings to Change for Texas Health Steps
Neonatal Level of Care Designation Required for Hospital Providers Rendering Neonatal Inpatient Services
Delegated Psychological Services to Allow More Than One Modifier on the Same Date of Service Effective July 1, 2019
Updated Limitation for Zika Virus Testing Effective July 1, 2019
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2017 Cultural Competency Plan
Medicare Advantage Asthma Care Training
Home Health Provider Training
DSNP Overview Training
Texas Health Steps CME
My Diverse Patients Training: Creating an LGBT-Friendly Practice
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Caring for Diverse Populations Toolkit
Elsevier Performance Manager Provider Registration
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2019 Texas Health Steps Training Schedule
Amerigroup provider orientation webinar training
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Quest Diagnostics, Inc. (Laboratory Services)
Texas Health Steps
Texas Medicaid & Healthcare Partnership
Texas Vaccines for Children
STAR+PLUS and IDD: What to Expect (Video Link)
Superior Vision
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