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Provider Resources & Documents
expand Claims Submission and Reimbursement Policy
HCA Provider Billing Guides and Fee Schedules
SERI Billing Guide July 1, 2018
HCA SERI Guidance June 21, 2019
expand Clinical Practice Guidelines
Developmental screening, assessment and referral – last updated 8/21/17
Preventive Health Guidelines (Spanish)
expand Disease Management
About Disease Management
How to Use Disease Management
expand Enhanced Personal Health Care Program
Medicare Advantage Medical Panels
Program Overview
Availity Access to Reports
expand EPSDT
EPSDT Provider Training
EPSDT Toolkit - Spanish
expand HEDIS Training
HEDIS Behavioral Health Presentation
HEDIS Pediatric screening and prevention measures presentation
expand ICD-10
Medicare Advantage Medical Record Documentation & Coding Tips
expand Manuals & QRCs
No Cost Member Services
Medicaid Quick Reference Card
Provider Manual Addendum for Service Encounter Reporting Instruction (SERI)
expand Maternal Child Program
Breast pump request form
Zika Virus Information Packet
Long-acting, reversible contraception device inventory and separate inpatient reimbursement
OB Department Chair notification letter regarding long-acting, reversible contraceptive devices
Coding Spotlight — Pregnancy
Prenatal Ultrasound Policy
expand Medical Management Model
Care Management
Medical Management Model
expand Newsletters - Archived
April 2016 News Bulletin
December 2015 News Bulletin
February 2016 News Bulletin
January 2016 News Bulletin
July/August 2015 News Bulletin
June 2016 News Bulletin
March 2016 News Bulletin
May 2016 News Bulletin
October 2015 News Bulletin
September 2015 News Bulletin
November 2016 News Bulletin
January 2017 News Bulletin
March 2017 News Bulletin
May 2017 News Bulletin
July 2017 News Bulletin
September 2017 News Bulletin
November 2017 News Bulletin
February 2018 Provider Newsletter
June 2018 Provider Newsletter
October 2018 Provider Newsletter
expand Newsletters - Current
February 2019 Provider Newsletter
June 2019 Provider Newsletter
October 2019 Provider Newsletter
expand Pharmacy
Medical Injectables Prior Authorization
Pharmacy Benefits Page
Synagis Enrollment Form
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
Medicare Quality Improvement Programs
HEDIS Benchmarks and Coding Guidelines
expand Quick Tools
Reimbursement Policies
Requesting preauthorization for the Bariatric Surgery program
Tribal Quick Tips
National drug code: frequently asked questions
Medicare Advantage 2020 Products
expand Training Programs
Cultural competency and patient engagement
My Diverse Patients Training: Breast Cancer Screening for African American Women
My Diverse Patients Training: Reducing Health Care Stereotype Threat
New Provider Orientation Presentation
Keys to great health care communication
Ask Me 3 Flier - English'
Caring for Diverse Populations Toolkit
2019 Joint Medicaid Provider Training
2019 Apple Health Medicaid Provider Training
expand Tutorials
Precertification Status and Appeals Tutorial
Provider Updates: Account Information
Medication Precertification Tutorial
expand Vendor/Partner Links & Information
LabCorp (Laboratory Services)
Quest Diagnostics, Inc. (Laboratory Services)
Pathology Associates Medical Laboratories, LLC (PAML)
Tri-Cities Laboratory
AIM (Chemotherapy and Therapeutic Authorizations)
expand Women Infants and Children
Women Infants and Children

Do more online through Provider Self-Service!

  • File and check the status of medical claims
  • NEW — Submit Claims Payment Disputes electronically via Availity
  • Verify eligibility
  • Request precertification via the Interactive Care Reviewer (ICR)
  • Conduct an inquiry on the status of any precertification request via ICR
  • For more information on ICR such as features, support or training go to
  • Submit a Pharmacy Prior Authorization Request
  • And much more!

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Amerigroup Washington, Inc.'s rating increased from 3.0 to 3.5 out of 5 in NCQA's Private Medicaid Health Insurance Plan Ratings 2017-2018.