Prior Authorization | Providers – Amerigroup

Medicaid and Medicare Part B

Click the Health Plan location to download the required Prior Authorization Request Form.

Florida
Georgia
Kansas-Medicaid
Louisiana

Maryland
Nevada
New Jersey

New York
Texas-Medicaid
Texas-Medicare
Washington

Florida Psychotropic Medication Guidelines for Children Younger than 13

Louisiana Synagis Enrollment Form

Medicare Part D

Contact Express Scripts Provider Services at 1-800-338-6180 or use the Provider Portal located here