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Provider Resources & Documents
expand Claims Submission and Reimbursement Policy
SERI Billing Guide July 1, 2018
expand Clinical Practice Guidelines
BH Screening Assessment and Treatment – last updated 10/1/15
Preventive Health Guidelines
Clinical Practice Guidelines Matrix
expand Disease Management
Contacting Disease Management
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 ICD-10
expand Manuals & QRCs
Medicaid Provider Manual
Medicare Provider Manual
Medicare Provider Dispute, Grievance and Appeal FAQ
expand Maternal Child Program
Maternity Notification Form
Healthy Rewards
New separate reimbursement for long-acting, reversible contraception devices
Provider notification letter regarding long-acting, reversible contraceptive devices with FAQ
Medically Intensive Children's program
New case management program for PTSD resulting from stays in the NICU
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
expand Newsletters - Current
June 2018 Provider Newsletter
October 2018 Provider Newsletter
February 2019 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
Find A Pharmacy
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
Medicare Quality Improvement Programs
HEDIS Benchmarks and Coding Guidelines
expand Quick Links
expand Quick Tools
Precertification Lookup Tool
Medical Policies
Credentialing Quick Tips
Women’s Health Quick Tips
expand Training Programs
Cultural Competency Training
Moving Toward Equity in Asthma Care CME
DSNP Overview Training
My Diverse Patients Training: Creating an LGBT-Friendly Practice
My Diverse Patients
2018 Joint Medicaid Provider Training
Keys to great heatlh care communication
Ask Me 3 Flier - English'
Caring for Diverse Populations Toolkit
expand Tutorials
Claims Appeals Tutorial
Precertification Request Tutorial
Member Information and Panel Listing
Accessing remittance inquiry process guide
expand Vendor/Partner Links & Information
Washington Health Care Authority (HCA)
Express Scripts Provider Portal
ESI Pharmacy Locator Tool
PACLAB, LLC (a joint venture with PAML in Western WA)
eyeQuest (Vision Services)

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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Visit Frequently Asked Questions about Availity for more information.

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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.