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.

Please help us improve our provider website by taking this brief survey.
Medicare Advantage - Hospitals must use Medicare Outpatient Observation Notice
Medicare Advantage – 2017 Annual Notice of Change
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Medicare Advantage – Transitional Care Management Services Eligibility
Medicare Advantage – Verify Injectable, Infusion Billable Units Approved via AIM
Medicare Advantage - Routine Physical Exams are Covered in 2017
Medicare Advantage – DSNP Provider Training
Medicare Advantage – AIM Clinical Appropriateness Guidelines for Advanced Imaging
Medicare Advantage - Attend December Webinar/Webinars to Learn how to Complete OptiNet Assessments
Medicare Advantage - Cardioverter Defibrillators : Confirm if Authorization Required for Implants
Medicare Advantage – Avoid Needless Claims Denials with These Tips
Medicare Advantage - 2017 Benefits and Formularies Available
Medicare Advantage - Care Program Available for Members Facing Advanced Illness
Medicare Advantage - Prior Authorization Requirements for Cuvitru, Ocrevus and Lutathera
Medicare Advantage - Prior Authorization Requirements for Intracardiac Electrophysiological Studies and Catheter Ablation
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage - Prior Authorization Requirements for Erelzi, Amjevita, Voretigene neparvovec, Nanacog and Lartruvo
Medicare Advantage - Risk Adjustment and Documentation Guidance Training Offered
Medicare Advantage - 2017 Coverage Changes for Diabetic Supplies
2016 Medicare Clinical Practice Guideline Matrix
Medicare Advantage - Prior Authorization Requirements for Continuous Interstitial Glucose Monitoring
Medicare Advantage - Clarification for Requesting Authorization for certain Arterial Duplex Imaging Procedures
Quarterly pharmacy formulary change notice effective November 1, 2016
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Quarterly pharmacy formulary change notice effective September 1, 2016
Medicare Advantage - Amerigroup to Conduct Periodic Audits to Ensure CMS Requirements
Medicare Advantage - Use JW Modifier When Submitting Claims for Discarded Drugs
Medicare Advantage - Follow CMS Guidelines for Part B Immunizations Claims Filing
Medicare Advantage - Help Ensure Part D Members Receive a Comprehensive Medication Review
Medicare Advantage - Self-Administered Drugs cannot be Billed to Members
Medicare Advantage - Billing Requirements for TAVR and TMVR
Medicare Advantage - Amerigroup Follows CMS Guidelines for DME Customization
Medicare Advantage - Prior authorization requirements for Doxil and Sustol
Medicare Advantage - Prior Authorization changes to Interferon gamma-1b, Mecasermin, and Azacitidine
Medicare Advantage - Prior Authorization Requirement for Torisel
Elective one and two vessel coronary artery bypass graft to require prior authorization
Q2 Medical policies and Clinical Utilization Management (UM) Guidelines (9/28/16)
QVAR pharmacy formulary change notice effective September 1, 2016
Medicare Advantage – Prior Auth for Elective One and Two CABG
Medicare Advantage – Prior Auth for New Injectable/Infusible: Tecentriq
Medicare Advantage - Complete your Medicare Advantage AIM OptiNet® registration by Jan. 1, 2017
Medicare Advantage - Prior Authorization Requirements for Inflectra and Cinqair
Quarterly pharmacy formulary change notice effective October 1, 2016
Medicare Advantage - Prior Authorization Requirements for new Injectable/Infusible Drugs: Darzalex and Empliciti
Medicare Advantage - Prior Authorization Requirements for new Injectable/Infusible Drugs: Istodax, Ixempra, and Taltz
Medicare Advantage - Please Use Medicare Billing Guidelines when filing Preventive Services Claims
Medicare Advantage - Claim Adjustments May Change Member Cost Share
Medicare Advantage - Ensure the Accuracy of Your Information in the Provider Directory
Medicare Advantage - Home Health Billing Instructions
Medicare Advantage - Complying with Medical Record Documentation Requests
Medicare Advantage - Check Your Contract Prior to Rendering Supplemental Benefits
Medicare Advantage - In-Home Bone Mineral Density Testing
Medicare Advantage - Assisting Members with Rheumatoid Arthritis Who May Be Missing Important Medications
Medicare Advantage - Clinical Cumulative Morphine Equivalent Dosing Point of Sale Edit effective January 1, 2017
Medicare Advantage - Improve Member’s Medication Adherence with 90-Day Prescriptions
Medicare Advantage - Alendronate added to the $0 Copay Tier
Medicare Advantage - Complete Your Medicare Advantage AIM OptiNet Registration for X-ray, Ultrasound or High-Tech Imaging Services
Medicare Advantage - AIM Clinical Appropriateness Guidelines for Advanced Imaging effective November 1, 2016
Federal nondiscrimination and accessibility update
Medicare Advantage - Prior Authorization for Emend (Fosaprepitant), Aloxi (Palonosetron), and Afstyla (Antihemophilic)
Quarterly pharmacy formulary change notice
Medicare Advantage - Member Incentive for Annual Routine Physical
Precertification update for vascular embolization or occlusion services
Medicare Advantage - Prior Authorization Requirements for Vascular Embolization or Occlusion Services
ClaimsXten Upgrade
Quarterly pharmacy formulary change notice effective July 1, 2016
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Medicare Advantage - Dual Advantage Simple Billing Tips
Frequently asked questions – Health Care Authority (HCA) Earlier Enrollment
Medicare Advantage - AIM OptiNet Imaging Services Initiative Postponed
Electric breast pump sole source vendor change
Medicare Advantage - Part D Drugs must be Prescribed for FDA-Supported Indications, Medicare Compendiums
Update: Certain drugs to require prior authorization
Medicare Advantage - Outpatient Part B Nursing and Long-Term-Care Facilities: Contact OrthoNet for OT and PT Prior Authorizations
Medicare Advantage – Contact Medicare Part B Specialty Pharmacy before Injections, Infusion Drug Prior Authorization Expire
Medicare Advantage - Inpatient Stays and Observation : Please Help Members Maximize Health Benefit
Precertification for knee and spine orthoses effective August 1, 2016
Medicare Advantage - Notification of Prior Authorization Requirement for Non-Emergency Ambulance Transport for Medicare Advantage, MMP, and D-SNP Members to and from Dialysis Treatment
Scoliosis and Spinal Deformity Medical Necessity Reviews
Update on Pharmacy Prior Authorization Submissions
Medicare Advantage-AIM Oncology and Oncology Drugs
Medical policies update
Medicare Advantage - UPDATED: Skilled Nursing Facilities, Home Health and Long-term Care Facilities: OrthoNet OT and PT Prior Authorization Delayed until Further Notice
Medicare Advantage - DSNP Training Required
Medicare Advantage - Quality Programs Support Patient Safety, Health Improvement
Medicare Advantage - AIM to Conduct Medical Necessity Reviews for Vascular Ultrasound Procedures
Medicare Advantage - Reminder to include the “Rendering Provider Location” for Radiology Services
Quarterly pharmacy formulary change notice
Medicare Advantage - Quarterly Update to the Medicare Physician Fee Schedule
Medicare Advantage - AIM OptiNet imaging provider registration Frequently Asked Questions
Medicare Advantage - Additional Radiation Oncology Prior Authorizations Should Be Directed to AIM Effective July 1, 2016
Medicare Advantage - UPDATED: Imaging Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage - New Prior Authorization Requirements Effective May 1, 2016
Medicare Advantage - Accurate Information about Your Practice
Medicare Advantage - HIPPS Codes Required for SNF and HHA Claims
Medicare Advantage - Contact OrthoNet for OT and PT Precertifications in SNF, HH, and LTC
Medicare Advantage - Medicare Notices and Provider Requirements
Medicare Advantage - Please Review Rx Changes to Help Members Find the Best Medication Values
Medicare Advantage - Additional Support Available for Members with Rare Conditions
Outpatient therapies authorization requirements change
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage - Webinar for all Imaging Providers
Quarterly pharmacy formulary change notice
Quarterly Formulary Change Notice Effective December 1, 2015
Medicare Advantage - Register for Imaging Site Scores by March 1, 2016, to Avoid Unnecessary Line-Item Denials
Medicare Advantage - Avastin for Ophthalmic Use
Medicare Advantage - More $0 Copay Medication Available to Members with Chronic Conditions
Medicare Advantage - Avoid Denials of Diagnostic Claims by Completing Item 20 (CMS 1500) Correctly
Medicare Advantage - Providers Must Enroll with Medicare to Prescribe Part D
Medicare Advantage - Amerigroup Encourages High-Risk Members to get a Flu Shot
Medicare Advantage - 2016 Plan Changes
Medicare Advantage - Diabetic Supply Changes for 2016
Medicare Advantage - Routine Physicals for 2016
Medicare Advantage - Imaging Site Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage - New 2016 prior authorization requirements effective January 1, 2016
Medicare Advantage - Part B Updates for Praluent, Repatha and Sylvant
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Prior authorization required for drugs Entyvio and Cyramza
Medicare Advantage - Precertification update for scoliosis and spine deformity
Behavioral Health: Authorization Requirement Changes Effective November 1, 2015
Cervical Length Screening Guidelines
Home Health Therapy Codes Update Effective September 1, 2015
Important Notice for Amerigroup Providers Regarding Durable Medical Equipment and Medical Supply Services
DME Vendor Orientation Invitation
Medicare Advantage - Participating Providers: Bill Medicare Part D for Shingles or Tetanus Vaccination Claims
Medicare Advantage - 2015 Retrospective Medical Record Review 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.
June 2015 Provider Orientation Webinar Invite
Medicare Advantage - New Precertification Requirements Effective September 1, 2015
May 2015 Provider Orientation Webinar Invite
Medicare Advantage - Part B Drug Reminder
Medicare Advantage - Precertification Required for Hemophilia Drugs
Pharmacy Formulary Change Notice Effective April 1, 2015​
Medicare Advantage - Recovery Look-Back Period to Align with CMS
Medicare Advantage - Select Cardiac Services to Be Reviewed
Medicare Advantage - Intensive Outpatient Program Services
Phone number change for Part B benefits
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
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
New 2015 precertification fax number for skilled nursing, long term acute care and inpatient rehab
Medicare Amerivantage PBM Conversion
minus font size default font size plus font size

Provider Self-Service

 Provider Resources & Documents

expand Behavioral Health
expand Claims Submission and Reimbursement Policy
Electronic Data Interchange (EDI)
expand Clinical Practice Guidelines
Developmental screening, assessment and referral – last updated 10/1/15
2016 Preventive Health Guidelines (English)
2016 Medicare Clinical Practice Guideline Matrix
expand Disease Management Centralized Care Unit
Contacting DMCCU
expand Enhanced Personal Health Care Program
Medicare Advantage Medical Panels
Program Overview
expand EPSDT
EPSDT Reminder Program
expand Forms
Hysterectomy & Sterilization Forms
Growth Hormone for Adults Request
OB/GYN Encounter Form
Outpatient Therapy Progress Report
Provider Payment Dispute and Correspondence Submission Form
Provider Demographic Update Form
BH Outpatient Treatment Report
BH Concurrent Review Fax Form - Medicare
DSM-5 Checklist
Precertification Request Form
Functional Progress Chart
Hospital Communication Log
Request for a Change of Primary Care Provider
Practice Profile Update Form
Neuropsychological Testing Request Form Medicare
expand ICD-10
Medicare ICD-10 Coding Changes
expand Manuals & QRCs
No Cost Member Services
Medicare Provider Manual
expand Maternal Child Program
Prenatal ultrasound reimbursement
Electric breast pump request form
Zika Virus Information Packet
expand Medical Management Model
Health Education and Wellness
expand Newsletters
April 2015 News Bulletin
August 2016 News Bulletin
February 2015 News Bulletin
January 2015 News Bulletin
July 2016 News Bulletin
June 2015 News Bulletin
March 2015 News Bulletin
May 2015 News Bulletin
November 2015 News Bulletin
October 2016 News Bulletin
September 2016 News Bulletin
December 2016 News Bulletin
expand Pharmacy
Pharmacy Tools
Natn'l Drug Code FAQs
Medication Assisted Treatment Form - Buprenorphine Monotherapy
Medication Assisted Treatment Form - IM Naltrexone
Washington Preferred Drug List
expand Quality Management
Medicare Advantage – Clinical HEDIS Medicare Stars Quick Reference Guide
Medicare Quality Improvement Programs
expand Quick Tools
Reimbursement Policies
Requesting preauthorization for the Bariatric Surgery program
Tribal Quick Tips
expand Referral Directories
Washington East Referral Directory
expand Training Programs
Universal Development Screening in Primary Care Orientation
DSNP Overview Training
Cultural Competency Toolkit
expand Tutorials
Precertification Status and Appeals Tutorial
Provider Updates: Account Information
Member Information and Panel Listing
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
  • Verify eligibility
  • Request precertification
  • Submit a Pharmacy Prior Authorization Request
  • And much more!

To log in, use your Availity ID and password. If you need an Availity ID, visit www.Availity.com to register today. Visit Frequently Asked Questions about Availity for more information and how to register for continued access to this information.