Washington | Providers – Amerigroup

News & Announcements

You can submit precertification requests, including clinical notes, by fax to 1-800-964-3627 as an alternative to online requests. The precertification request form is in the Forms section of this page.

Medicare Advantage - Select Cardiac Services to Be Reviewed
Medicare Advantage - Intensive Outpatient Program Services
Phone number change for Part B benefits
March 2015 News Bulletin
Encourage Medicare Advantage Members to Stay Up-to-Date on Preventive Care
OrthoNet to conduct post-service prepay reviews
Medicare Advantage - ClaimCheck Version 55 Upgraded Effective April 1, 2015
Pharmacy Formulary Change Notice Effective March 1, 2015​​
Medicare Reimbursement Policy Bulletin 2015, Issue 1
February 2015 News Bulletin
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 Washington, Optum Collaborating To Ensure Members Receive Regular Exams, Preventive Screenings
Medicare Advantage: OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews
January 2015 News Bulletin
New 2015 precertification fax number for skilled nursing, long term acute care and inpatient rehab
Medicare Amerivantage PBM Conversion
December 2014 Provider News Bulletin
Medicare Advantage: Provider Requirements and Medicare Notices
Medicare Advantage 2015 Annual Notice of Change in Products
Provider News Bulletin - November 2014
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
Flu Vaccinations
Medicare Advantage Peer to Peer Changes
Inpatient Readmissions
Encourage Exercise to Prevent Falls
Pharmacy Benefit Manager Change to Express Scripts, Inc. Effective November 1, 2014​
October 2014 Provider Bulletin
Upcoming changes to durable medical equipment precertification requirements
Postponed Upcoming Disbursement Process Changes
Health Homes - A holistic approach to care
Quarterly Pharmacy Formulary Change Notice
Improve Your Immunization Rates
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
SBIRT Provider Training Available - Practitioners will learn how to screen people for substance use disorders and apply a brief negotiated interview to build motivation for change and link to appropriate services. This presentation will discuss the research and rationale for widespread implementation of SBIRT; teach participants how to use common screening instruments, describe, demonstrate and educate participants on how to perform a brief negotiated interview; and learn how SBIRT could be set-up in a clinic and explore protocols for referral to treatment.
Attention Behavioral Health Providers – Please respond to our brief survey to keep us informed of the services your practice currently performs.
Pharmacy Behavioral Health Medication Notice
Register Now for Availity
Availity Announcement and Frequently Asked Questions
Coming Soon! Enhanced Online Precertification Tool
Updated CMS 1500 Form
Quarterly Pharmacy Formulary Change Notice
Medicare Advantage Product Highlights Provider Letter
Medicaid Expansion Benefts Begin January 1, 2014
PCP Rate Increase Manual Update
Quarterly Pharmacy Formulary Change Notice
New Website Password Requirements
Medication Precertification Tool Available Now
Precertification Appeals Tool Available
Online Claims Appeals Tool Available
Quarterly Pharmacy Formulary Change Notice
Preventing the Flu
Updated Clinical Practice Guidelines Now Available
May 1, 2013, Change to UniCare CPBs & Guidelines
Our Medicaid ID Cards Have Gone Mobile!
Interpreter Services Now Provided Through CTS LanguageLink of Vancouver
Our New Online Provider Directory: Built for Providers and Members
Changes to Inpatient Precertification/Claims for CPE Hospitals Effective July 1, 2012.
Assess and Strengthen Your Cultural Competency.
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Provider Self-Service

 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 2
expand Clinical Practice Guidelines
BH Screening Assessment and Treatment - last updated 12/10/2014
Clinical Practice Guidelines Matrix - last updated 02/09/2015
expand Disease Management Centralized Care Unit
Contacting DMCCU
expand EPSDT
EPSDT Reminder Program
expand Forms
Hospital Communication Log
Family Practice Encounter Form
Internal Medicine Encounter Form
Outpatient Therapy Initial Evaluation
Pediatric Encounter Form
Refund Notification Form
Training Verification Form
Practitioner Clinical Medical Record Audit
Primary Care Provider Change Request Form - English
Precertification Request Form
BH Concurrent Review Fax Form - Medicare
expand Frequently Asked Questions
Provider FAQs
expand ICD-10
expand Manuals & QRCs
Washington Provider Manual
2015 Medicare Provider Manual Updates
expand Maternal Child Program
17P Order Form
Prenatal Ultrasound Policy
expand Medical Management Model
Health Education and Wellness
HEDIS® Benchmarks and Coding Guidelines for Quality Care
expand Newsletters
Provider News Issue 1 2013
Provider News Issue 3 2014
expand Pharmacy
Washington Formulary
Natn'l Drug Code FAQs
Common OTC Medications List
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
expand Quick Tools
Reimbursement Policies
expand Referral Directories
Washington East Referral Directory
Washington Medicare Referral Directory
expand Training Programs
SBIRT Provider Training
expand Tutorials
Claims Appeals Tutorial
Precertification Request Tutorial
Medication Precertification Tutorial
expand Vendor/Partner Links & Information
LabCorp (Laboratory Services)
Ocular Benefits (Vision Services)
Quest Diagnostics, Inc. (Laboratory Services)
AIM (Diagnostic and Imaging Service Authorizations)
Pathology Associates Medical Laboratories, LLC (PAML)
Tri-Cities Laboratory

Do more online through Provider Self-Service!

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  • Submit a Pharmacy Prior Authorization Request
  • And much more!

How will you access patient information after July 15, 2014?

On July 15, 2014, online member eligibility, benefit and claim status inquiries will no longer be available on this website. Visit Frequently Asked Questions about Availity for more information and how to register for continued access to this information.