Texas | Providers – Amerigroup

News & Announcements

Effective November 1, 2016 ClaimsCheck® upgrade to ClaimsXten™
Precertification update for vascular embolization or occlusion services
STAR Kids BH Provider Training Schedule
Update: Certain drugs to require prior authorization
Medicare Advantage - Member Incentive for Annual Routine Physical
STAR Kids LTSS Provider Training Schedule
Nursing Facility Training Schedule
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
Medicare Advantage - Care Program Available for Medicare Advantage Members Facing Advance Illness
Postpartum long-acting, reversible contraception benefit now available
Reminder: Texas Health Steps requirements
Primary care provider change form now available
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Medicare Advantage - Dual Advantage Simple Billing Tips
TX Network Improvement Program
Final notice to continue receiving Medicaid payments
Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
Medicare Advantage - Part D Drugs must be Prescribed for FDA-Supported Indications, Medicare Compendiums
Providers must re-enroll to be paid for Medicaid (STAR or STAR+PLUS) services
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
Revised Process For Medical Necessity Reviews For Therapy And Spine And Back Pain Management
Medicare Advantage - Inpatient Stays and Observation : Please Help Members Maximize Health Benefit
Correction to 2015 provider update regarding the revised process for medically necessary reviews
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
MMP - Additional radiation oncology prior authorizations should be directed to AIM Specialty Health® (AIM) effective July 1, 2016
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
Community First Choice
Fee Schedule Notice
DMEPOS Fee Schedule Notice
Medicare Advantage - CMS Selects Amerigroup for 2014 National RADV Audit
Physical, occupational and speech therapy authorization requirements
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
Nursing Facility 2016 Provider Orientation Webinar Schedule​
Updated Medicaid/CHIP Provider Manual available online
MMP- AIM Radiation Oncology Update
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
Long Term Care provider orientation webinar training schedule
MMP - AIM Radiation Oncology Phase I
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
2016 Provider Orientation Webinar Schedule
2016 Texas Health Steps Provider Training Webinar Schedule
Medicare Advantage - Webinar for all Imaging Providers
Interim Hospital Inpatient Claim Processing
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
Revised process for medical necessity reviews for therapy and spine and back pain management
MMP - Radiation therapy: select Brachytherapy, IMRT CPT codes to require prior authorization
Medicare Advantage - Radiation Therapy: Select Brachytherapy, IMRT CPT Codes to Require Prior Authorization
Nonemergency ambulance prior authorization update
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 and claim billing changes for 17P therapy
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
Nursing Facility Training Schedule
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage - Part B Updates for Praluent, Repatha and Sylvant
MMP: New Prior Authorization Form Coming September 1, 2015
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
Nonemergent Ambulance Transportation Authorizations
Cervical Length Screening Guidelines
Precertification for Part B Drugs Entyvio and Cyramza
Reminder: All providers must re-enroll in Texas Medicaid by March, 2016
Help Us Locate Children of Farmworkers
2015 Texas Pay for Quality Provider Incentive Plan
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
ICD-10 Coded Authorizations Accepted Effective June 1
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
All providers must re-enroll in Texas Medicaid by March 2016
2015 THSteps Webinar Schedule and Invite​
Reminder: Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) is live!
NDC Claims Processing Update
Medicare Advantage - Part B Drug Reminder
Medicare Advantage - Precertification Required for Hemophilia Drugs
Medicare Advantage - Recovery Look-Back Period to Align with CMS
OrthoNet Announcement and FAQ​
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
Retroactive TPI Assignment and the Claims Process: Update
Medicare Advantage - OrthoNet to conduct post service prepay reviews
Medicare Advantage - ClaimCheck Version 55 Upgraded Effective April 1, 2015
Maternity Services Reimbursement Policy Update
Medicare Advantage: Medicare Update to Pneumococcal Vaccine Policy
WellPoint, Inc. is now Anthem, Inc.!​
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
Provider Manual Update: PPR and PPC Information​
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
2015 Dallas/Tarrant and MRSA Webinar Training Schedule
New 2015 Medicare Advantage precertification fax number for skilled nursing, long term acute care and inpatient rehab
Medicare Amerivantage PBM Conversion
PCP Rate Increase Decommissioning Bulletin​
Medicare Advantage: Provider Requirements and Medicare Notices
Medicare Advantage 2015 Annual Notice of Change in Products
Patient360 Lets You Access Member Records in a Few Clicks
Newborn Diagnostic Related Group Precertification and Claims Processing
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
Nonemergent Transportation Update
Updated Information on Targeted Case Management and Mental Health Rehab Services​
Upcoming Disbursement Process Changes
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Attention Behavioral Health Providers - Please respond to our brief survey to keep us informed of the services your practice currently performs.
Targeted Case Management and Mental Health Rehab Services
Bone Density Testing for Medicare Members
Medicare Advantage Members to Receive Monthly Summary Statements
Update to Requirements for Obstetric Delivery Claims and Diagnosis Codes
Effective July 21: Update to Requirements for Ordering or Referring Claim Submissions
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
Updated CMS 1500 Form
Improving Access to Behavioral Health Providers and Services
Texas Nonemergent Transportation Changing to Access2Care
Notification of Web Search Tool
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
REMINDER: Personal Attendant Services Timesheet Signature Requirement
Hospital Corporations of America (HCA) Returns to Network
Attendant Care Enhancement Program Open Enrollment
Prior Authorization Requirements Update - Nutritional Formulas
2013 Legislative Changes Summary (Professional, Ancillary, and Facility)
New Website Password Requirements
Precertification Requirements Training
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.

 Provider Resources & Documents

expand Behavioral Health
Primary Care and Behavioral Health Providers: Working Together to Treat the Whole Person Flier
Depression Screening
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 2
Electronic Data Interchange (EDI)
expand Clinical Practice Guidelines
expand Disease Management Centralized Care Unit
How to Use DMCCU
expand Enhanced Personal Health Care Program
Measurement Period Handbook
Program Description for the EPHC
expand EPSDT
Improving EPSDT Screening for Members​
expand Forms
TCM/MHR Services Request Form
BH Initial Review Fax Form - Medicare
BH Concurrent Review Fax Form - Medicaid
Transitions program appointment worksheet
Prior Authorization Request Form
Recoupment Notification Form MMP
PCP Change Request Form (Spanish)
expand ICD-10
Medicare ICD-10 Coding Changes
expand Manuals & QRCs
Medicaid/CHIP Provider Manual
2015 Medicare Provider Manual Updates
expand Maternal Child Program
Maternity Notification Form
Program Overview
Healthy Rewards Flier
expand Medical Management Model
Health Education and Wellness
expand MultiPlan
Quick Reference Guide
Network Application Form
expand Newsletters
Provider News Issue 2 2012
Provider News Issue 4 2012
Provider News Issue 3 2014
Provider News Issue 2 2015
Provider News Issue 4 2015
Provider News Issue 2 2016
expand Pharmacy
Natn'l Drug Code FAQs
Texas Medicaid/Chip Drug Code Formulary Search
Texas Vendor Drug Program Preferred Drug List (PDL)
Pharmacy Prior Authorization Forms
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
Medicaid and Medicare QM Desktop Reference Guide
expand Quick Tools
Reimbursement Policies
expand STAR+PLUS Medicare-Medicaid Plan program
Dual Eligibles Integrated Care Demonstration Project FAQs
BH Concurrent Review Form
BH Discharge Note
BH Outpatient Treatment Form
STAR+PLUS MMP Provider Orientation
HHSC Provider Beneficiary Rights Letter​
STAR+PLUS MMP Formulary - Spanish
expand State Communications
EVV vendor update - Sandata Technologies, LLC
Small Alternative Device Agreement Form: ENGLISH
UPDATE: Santrax System Fixed Verification Devices​
HHSC EVV Reason Code Training
EVV Implementation Additional Dates
HHSC EVV Implementation Delay for PDN Services
HHSC EVV Data Integrity Instructions​
EVV: Delay in Payors Imposing Compliance Penalties
EVV Vendor CM2000 HHSC Contract Nonrenewal Notice
Re-enrollment-Town-Hall Information
DADS LTSS Re-enrollment Information
HHSC EVV Notice: EVV Remains Mandatory
EVV extended from 21 to 60 calendar days
Missing, incomplete or inaccurate data will result in EVV system lockout from visit maintenance entry
Provider Compliance Plan for Contracted Provider Agencies
expand Training Programs
2016 Cultural Competency Plan
DSNP Overview Training
expand Tutorials
Claims Appeals Tutorial
Precertification Status and Appeals Tutorial
Provider Updates: Account Information
expand Vendor/Partner Links & Information
LabCorp (Laboratory Services)
Texas Department of Aging and Disability Services
Health and Human Services Commission
Clinical Pathology Laboratories (CPL)
Express Scripts Provider Portal
AIM (Diagnostic and Imaging Service Authorizations)
Express Scripts Prior Authorization
Express Scripts MAC Pricing

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!

How will you access patient information after September 30, 2015?

On September 30, 2015, online member eligibility, benefit and claim status inquiries will only be available at www.Availity.com. Avoid business disruptions – work with your office staff today to register for and begin using the Availity Web Portal.

Visit Frequently Asked Questions about Availity for more information.

Join Amerigroup's Provider Network

In a Rural Service Area (RSA) county?

We are contracted with the MultiPlan, Inc. (MPI) Texas True Choice (TTC) network for the RSA as our network. To become a participating provider with TTC, please call 1-866-971-7427 or submit your request for application.

In a non-RSA county?

Call our Texas Centralized Credentialing department at 713-218-5112.