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 Provider Resources & Documents

expand Claims Submission and Reimbursement Policy
expand Clinical Practice Guidelines
BH Screening Assessment and Treatment – last updated 10/1/15
2017 Preventive Health Guidelines
Clinical Practice Guidelines Matrix
expand Disease Management Centralized Care Unit
Contacting DMCCU
Disease Management Referral Form
expand Enhanced Personal Health Care Program
Measurement Period Handbook
Program Description for the EPHC
expand EPSDT
EPSDT Reminder Program
EPSDT Toolkit - English
expand Forms
Behavioral Health Discharge Note
expand ICD-10
Medicare Advantage Medical Record Documentation & Coding Tips
expand Manuals & QRCs
No Cost Member Services
Medicare Provider Manual
Medicare Provider Dispute, Grievance and Appeal FAQ
expand Maternal Child Program
Prenatal ultrasound reimbursement
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
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
expand Newsletters - Current
February 2018 Provider Newsletter
June 2018 Provider Newsletter
October 2018 Provider Newsletter
expand Pharmacy
Pharmacy Tools
Synagis Enrollment Form
OTC Preferred Drug List
Opioid Clinical Criteria - State Policy
Opioid PA with Attestation Form
Medication Treatment Guidelines for Substance Use Disorders (SUDs) - Buprenorphine Containing Products
expand Quality Management
Quality measures desktop reference for Medicare and Medicaid providers.
Advance directives or physician orders for life-sustaining treatment
expand Quick Tools
Precertification Lookup Tool
Medical Policies
Credentialing Quick Tips
Women’s Health Quick Tips
expand Training Programs
Cultural Competency Training
Medicare Advantage Asthma Care Training
My Diverse Patients Training: Breast Cancer Screening for African American Women
My Diverse Patients Training: Reducing Health Care Stereotype Threat
New Provider Orientation Presentation
Consumer Assessment of Healthcare Providers and Systems
Ask Me 3 Questionnaire (both Eng and Spn)
Ask Me 3 Flier - Spanish
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)
AIM (Diagnostic and Imaging Service Authorizations)
Pathology Associates Medical Laboratories, LLC (PAML)
Tri-Cities Laboratory
AIM (Chemotherapy and Therapeutic Authorizations)

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.