Texas | Providers – Amerigroup
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News & Announcements

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
Medicare Advantage - Radiation Therapy: Select Brachytherapy, IMRT CPT Codes to Require Prior Authorization
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 Nursing Facility Training Schedule​
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
Screening, Brief Intervention and Referral to Treatment (SBIRT) Flier
Behavioral Health Case Management Flier
expand Claims Submission and Reimbursement Policy
Provider Bulletin 2014, Issue 1
Provider Bulletin 2014, Issue 3
expand Clinical Practice Guidelines
Clinical Practice Guidelines Matrix
expand Disease Management Centralized Care Unit
Contacting DMCCU
expand Enhanced Personal Health Care Program
Medicare Advantage Medical Panels
Program Description for the EPHC
expand EPSDT
EPSDT Reminder Program
expand Forms
Precertification Request Form
TCM/MHR Services Request Form
BH Initial Review Fax Form - Medicare
BH Concurrent Review Fax Form - Medicaid
Transitions program appointment worksheet
OrthoNet: Spinal Surgery PA
expand ICD-10
ICD-10
expand Manuals & QRCs
Medicaid/CHIP Provider Manual
2015 Medicare Provider Manual Updates
Medicaid & Medicare QM Desktop Reference Guide
expand Maternal Child Program
Prenatal Ultrasound Policy
17P Order Form
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
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
2014 Quality Improvement Summary
expand Quick Tools
Precertification Lookup Tool
Medical Policies
expand STAR+PLUS Medicare-Medicaid Plan program
Precertification Request Form - MMP
BH Coordination of Care Form
BH Inpatient Initial Review Form
STAR+PLUS MMP Formulary
Amerigroup STAR+PLUS Medicare-Medicaid Plan (MMP) Provider Manual
expand State Communications
EVV vendor update - Sandata Technologies, LLC
Small Alternative Device Agreement Form: ENGLISH
Medicaid EVV System Selection Form
Telephone Types Acceptable for EVV Use​
HHSC EVV Reason Code List
EVV Temporary Extension of Visit Maintenance
EVV Requirements for Community First Choice Services​
HHSC MMP and STAR+PLUS Dual Members Beneficiary Rights ​
HHSC EVV Requirements for CFC Services​
expand Training Programs
2015 Cultural Competency Plan
DSNP Plans for 2015 FAQ
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
Texas

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 are you accessing patient information?

Online member eligibility, benefit and claim status inquiries are 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.