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COVID-19 News and Resources

Medicare Advantage -Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ (May 6, 2021)
COVID-19 information from Amerigroup (April 2021 update)
Maximizing efficient, high quality COVID-19 screenings (April 12, 2021)
Medicare Advantage — COVID-19 information from Amerigroup (April 2021 update) —Updated to add vaccine information
Medicare Advantage - Maximizing efficient, high quality COVID-19 screenings (March 30, 2021)
MMP -COVID-19 information (January 5 update)
DSHS COVID-19 Vaccine FAQs (January 5, 2020)
COVID-19 update: Suspension of select prior authorization rules and significant policy adjustments in response to unprecedented demands on health care providers (updated December 24, 2020)
Medicare Advantage — COVID-19 update: Amerigroup suspends select prior authorization rules and announces significant policy adjustments in response to unprecedented demands on health care providers (December 24, 2020)
Existing EVV Users: Temporary EVV Policies for COVID-19 to End Dec. 31 (December 2, 2020)
Update to COVID-19 extension of prior authorizations (December 1, 2020)
Medicare Advantage — COVID-19 Medicare Telehealth FAQ (November 11, 2020)
Update to COVID-19 extension of prior authorizations (October 5, 2020)
HHSC 2020 COVID-19 Impact Survey (November 4, 2020)
Provider Vaccine Information - How to Become a COVID-19 Vaccinator
EVV Users: Temporary Policies for COVID-19 Extended to 10/23/2020 (August 11, 2020)
HHS announces additional distributions from the Provider Relief Fund to eligible Medicaid and CHIP providers (6/15/2020)
Medicare Advantage — HHS announces additional distributions from the Provider Relief Fund to eligible Medicaid and CHIP providers (6/15/2020)
COVID-19 extension of prior authorizations (June 15, 2020)
Medicare Advantage — COVID-19 update: Guidance for telehealth/telephonic care for behavioral health services (June 10, 2020)
Guidance for telehealth/telephonic care for behavioral health services (June 9, 2020)
Prior authorization codes moving from AIM Specialty Health to Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan)
Medicare Advantage — Prior authorization codes moving from AIM Specialty Health to Amerigroup
Medicare Advantage — Telehealth services for risk adjustment payments Coronavirus (COVID-19) update: May 8, 2020
Information for FMSAs and Consumer Directed Services (CDS) Employers on the Families First Coronavirus Response Act
Updated Guidance: Texas Health Steps Medical Checkups via Remote Delivery During Implementation of COVID-19 Restrictions
Medicare Advantage — Federal resources available for health care providers and employers in the federal CARES Act
Listen now! Webinar recording available from Amerigroup for network providers on SBA loans and other federal relief programs in response to COVID-19
Medicare Advantage -Listen now! Webinar recording available from Amerigroup for network providers on SBA loans and other federal relief programs in response to COVID-19
Resources supporting our providers during COVID-19
COVID-19 update: Amerigroup suspends select prior authorization rules and announces significant policy adjustments in response to unprecedented demands on health care providers
Federal resources available for health care providers and employers in the federal CARES Act
HHSC OIG Notice
HHSC Cares Information Sheet
Medicare Advantage — Integrated Crisis Support Program
Medicare Advantage — Amerigroup waives cost share for COVID-19 treatment
COVID-19 update for therapy providers
Health and Human Services Commission Electronic Visit Verification Temporary EVV Policies for Novel Coronavirus (COVID-19) (March 24, 2020)
Existing EVV Users: Temporary Policies for COVID-19 (March 24, 2020)
Health Alert: Recommendations for Healthcare Personnel Evaluating Patients for Possible 2019 Novel Coronavirus (2019-nCoV) Infection

News & Announcements

HB1576 Implementation of Nonemergency Medical Transportation
MMP - Medical Policies and Clinical Utilization Management Guidelines update
MMP - PA Removal Notice for Avastin and its Biosimilars Retraction Notice
Federally qualified health centers and rural health clinic modifier requirements
Medicare Advantage - Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage -Reimbursement Policy Reminder: Inpatient Readmissions
Clinical Criteria Updates Notification February 2021
Medicare Advantage - Clinical Criteria Updates Notification February 2021
MMP - Clinical Criteria Updates Notification February 2021
MMP -Important update: behavioral health fax numbers changing
Medicare Advantage - FAQ medical records risk adjustment
Medicare Advantage - Updates to the AIM Advanced Imaging Clinical Appropriateness Guidelines
Updates to the AIM Advanced Imaging Clinical Appropriateness Guidelines
Important update: behavioral health fax numbers changing
MMP- Medicare Part B Precert Expansion - Effective 7/1/21
Medicare Advantage: Medicare Part B Precert Expansion - Effective 7/1/21
Medicare Advantage - Updates to the AIM Specialty Health Musculoskeletal Program Clinical Appropriateness Guidelines
Medicare Advantage - Amerigroup working with Optum to collect medical records for Medicare risk adjustment (MRA)
Medicare Advantage - Helping our members
MMP - Helping our members
MMP - Clinical Criteria Updates Notification December 2020
Medicare Advantage - Clinical Criteria Updates Notification December 2020
Clinical Criteria Updates Notification December 2020
MMP - Clinical Criteria Updates Notification November 2020
Medicare Advantage - Clinical Criteria Updates Notification November 2020
Prior authorization update for incontinence supplies
There is something new happening at Amerigroup
MMP Medicare Part B Precert Expansion - IV Iron - Effective 5/1/21
Medicare Advantage Part B Precert Expansion - IV Iron - Effective 5/1/21
November 2020 Medical Policies and Utilization Management Guidelines update 2/11/2021
Clinical Criteria Updates Notification November 2020
Specialty Pharmacy Prior Authorization Updates
Some HIV medication combinations may require prior authorization
MMP November 2020 Medical Policies and Utilization Management Guidelines update (February 3, 2021)
Medicare Advantage November 2020 Medical Policies and Utilization Management Guidelines update (February 3, 2021)
MMP - Facility Discharge Provider Information
MMP New Specialty Pharmacy Medical Step Therapy Requirements - Effective May 1, 2021
MMP MCG Care Guidelines 24th edition customization
Medicare Advantage MCG Care Guidelines 24th edition customization
MCG Care Guidelines 24th edition customization
Medicare Advantage - DME checklist of information needed from providers
Notice to Physicians and Providers
Availity attachment tools — live webinar
MMP — Racial Equity Series — The Road to Allyship: Playing Your Part in Racial Equity
Racial Equity Series — The Road to Allyship: Playing Your Part in Racial Equity
Medicare Advantage — Welcome to the Availity Portal — Provider Online Reporting overview
Medicare Advantage — Racial Equity Series - The Road to Allyship: Playing Your Part in Racial Equity
Medicare Advantage Expanded Specialty Pharmacy Precertification List - Effective April 1, 2021
MMP Expanded Specialty Pharmacy Precertification List - Effective April 1, 2021
Medicare Advantage — Amerigroup Amerivantage (Medi…ing two new Special Needs Plans for 2021 in Texas
Medicare Advantage — How to navigate Patient360 through the Availity Portal
Medicare Advantage — Claims Status Listing Reference Guide in the Availity Portal
Clinical Criteria Web Posting September and October 2020
MMP Clinical Criteria Web Posting September and October 2020
Texas Health Steps Provider Orientation Training Schedule
Prior authorization for Radiotherapies and Radioimmunotherapies
Provider notification for Utilization Management Authorization Rule Operations Workgroup Item 1326
Medicare Advantage — Clinical Criteria Web Posting September and October 2020
Medicare Advantage — PN for UM AROW Item 1330
Medicare Advantage — Updates to AIM Clinical Appropriateness Guidelines for Advanced Imaging
MMP — Expanded Specialty Pharmacy Precertification List - Effective March 1, 2021
Updates to AIM Clinical Appropriateness Guidelines for Advanced Imaging
Medicare Advantage — Medical Drug Benefits Clinical Criteria Updates August 2020
Clinical Criteria Web Posting (August 2020)
MMP Clinical Criteria Web Posting August 2020
Medicare Advantage — Expanded Specialty Pharmacy Precertification List - Effective March 1, 2021
MMP — Discharge summary
August 2020 Medical Policies and Utilization Management Guidelines update
MMP — August 2020 Medical Policies and Utilization Management Guidelines update
Help Youth Formerly in Foster Care Maintain Their Medicaid
Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines
Medicare Advantage — Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines
Healthy Texas Women (HTW) Plus Services Available September 1, 2020
Healthy Texas Women Needs New Providers
Specialty Pharmacy Prior Authorization Updates
Medicare Advantage — SNF admission reporting requirements for D-SNP plans
Medicare Advantage — Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
Essential/Everyday Extras
Updated claims submission requirements for Adult Day Center benefit
Personal Home Helper FAQ
Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
Medical Drug Benefits Clinical Criteria Updates (August 2020)
Sign up to receive email from Amerigroup
MMP — Follow-Up After Hospitalization for Mental Illness
Medicare Advantage — Provider Chat Flier
Providers can now receive and respond to postpay audit record requests via Change Healthcare’s Assurance Attach Assist
Medicare Advantage — Providers can now receive and respond to postpay audit record requests via Change Healthcare’s Assurance Attach Assist
InterQual October 2020 clinical criteria revisions
Expanded Specialty Pharmacy Precertification List – Effective January 1, 2021
Medicare Advantage — 2021 Service Area and Benefit
Medicare Advantage — Houston area provider town hall (Medicare/PPO)
Medicare Advantage — August 2020 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage — Expanded Specialty Pharmacy Precertification List — Effective February 1, 2021
Expanded Specialty Pharmacy Precertification List — Effective February 1, 2021
Medicare Advantage — Expanded Specialty Pharmacy Precertification List — Effective February 1, 2021
Medicare Advantage — Bexar County provider town hall (Medicare/PPO)
Expanded Specialty Pharmacy Precertification List – Effective January 1, 2021
Policy Reminder — Nurse Practitioner and Physician Assistant Services, Professional
MMP Policy Reminder — Nurse Practitioner and Physician Assistant Services, Professional
Medicare Advantage — Dallas-Fort Worth provider town hall (Medicare/PPO)
Transition to AIM small joint guidelines
MMP Expanded Specialty Pharmacy Precertification List — Effective February 1, 2021
Hurricane Delta and Laura Information for Medicaid Providers
Provider Digital Engagement
Change Healthcare Medical Attachment Functionality FAQ
Medicare Advantage — Change Healthcare Medical Attachment Functionality FAQ
MMP — Racial Trauma Forum Invitation
Racial Trauma Forum Invitation
Medicare Advantage — Racial Trauma Forum Invitation
Medicare Advantage Policy Update — Emergency Department: Leveling of Evaluation and Management Services
Procedures for submitting referrals for Medicare Advantage meal benefits requiring precertification
Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines
Medicare Advantage — Provider Chat — A fast, easy way to get your questions answered
How to Submit a Complaint as a Medicaid Provider
Attendant Care Enhancement Payment Program open enrollment
Medicare Advantage — AIM Musculoskeletal program expansion update
Prior authorization requirements for HCPCS code 55899
Expanded Specialty Pharmacy Precertification List — Effective January 1, 2021
MMP Clinical Criteria Web Posting June 2020
Medicare Advantage — Medical Drug Benefits Clinical Criteria Updates (June 2020)
Medicare Advantage — New Specialty Pharmacy Medical Step Therapy Requirements — Effective 1/1/2021
Hurricane Laura information for Medicaid providers
Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) expands specialty pharmacy precertification list — Effective January 1, 2021
Medicare Advantage — Provider Notification for UM AROW 1107
Incentive delay notice
Medicare Advantage — Provider Notification for UM AROW 1125
Prior authorization requirements for E0482
Texas Health Steps and extended ophthalmoscopy
Medicare Advantage — Evaluation and management services correct coding
Medical Drug Benefits Clinical Criteria Updates (June 2020)
Provider Chat — A fast, easy way to have your questions answered
Medicare Advantage — Update: Notice of changes to the AIM musculoskeletal program
Update: Notice of changes to the AIM musculoskeletal program
HHSC survey — care of pregnant and postpartum women
May 2020 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage — May 2020 Medical Policies and Clinical Utilization Management Guidelines update
MMP Medical Drug Benefits Clinical Criteria Updates (May 2020)
Prior authorization requirements for 0200T and 0201T
Medicare Advantage Medical Drug Benefits Clinical Criteria Updates (May 2020)
Medicare Advantage — Amerigroup expands specialty pharmacy precertification list
Medical Drug Benefits Clinical Criteria Updates (May 2020)
Amerigroup STAR+PLUS MMP expands specialty pharmacy precertification list
New MCG Care Guidelines 24th edition Viral Illness
Medicare Advantage — AIM Musculoskeletal program expansion
Medicare Advantage — New MCG Care Guidelines 24th edition Viral Illness
Provider demographics update
Medicare Advantage — Provider demographics update
Patient access to the Medicaid Medical Transportation Program
New Specialty Pharmacy Medical Step Therapy Requirements — Effective August 1, 2020
Medicare Advantage — Waived copays, deductibles and coinsurance for CCM, complex CCM and TCM
Submit behavioral health authorizations via our online Interactive Care Reviewer tool
Medicare Advantage — Amerigroup expands specialty pharmacy precertification list (Effective 9/1/2020)
MMP — Expansion of specialty pharmacy precertification list (Effective 9/1/2020)
Medicare Advantage Medical Drug Benefits Clinical Criteria Updates (March 2020)
MMP Medical Drug Benefits Clinical Criteria Updates (March 2020)
Medical Drug Benefits Clinical Criteria Updates (March 2020)
Medicare Advantage — Submit behavioral health authorizations via our online Interactive Care Reviewer tool
Updates to AIM musculoskeletal program clinical appropriateness guidelines
New emergency room requirement for hospitals
Medicare Advantage — Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines
Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
New behavioral health discharge call-in line
February 2020 Medical Policies and Clinical Utilization Management Guidelines update
Prior authorization requirements for angiographic evaluation of stenotic or thrombosed dialysis circuits
InterQual 2020 update
MMP — February 2020 Medical Policies and Clinical Utilization Management Guidelines Update
Medicare Advantage — February 2020 Medical Policies and Clinical Utilization Management Guidelines Update
Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline
MMP — 2020 affirmative statement concerning utilization management decisions
Special Needs Plans (SNPs) and Model of Care (MOC) overview
Medicare Advantage — Modifier use reminders
Medicare Advantage Resources supporting our providers during COVID-19
Medical Drug Benefits Clinical Criteria Updates (February 2020)
MMP Medical Drug Benefits Clinical Criteria Updates (February 2020)
Medicare Advantage Clinical Criteria Web Posting February 2020
Amerigroup expands specialty pharmacy precertification list
MMP — Expansion of specialty pharmacy precertification list
2020 affirmative statement concerning utilization management decisions
MMP — Optum to collect medical records for risk adjustment
Medicare Advantage — Amerigroup working with Optum to collect medical records for risk adjustment
Medicare Advantage — Amerivantage PR Presentation 2020
Medicare Advantage — Acquisition of Beacon Health Options
MMP — Acquisition of Beacon Health Options
MMP — Outpatient Rehabilitation Program transition: new prior authorization requirements
MMP MCG care guidelines — 24th edition
Medicare Advantage MCG care guidelines — 24th edition
MCG care guidelines — 24th edition
Medicare Advantage — Electronic submission is preferred method for requesting pharmacy prior authorization
MMP — Electronic submission is preferred method for requesting pharmacy prior authorization
Availity Provider Article and FAQs
Medicare Advantage — Prior authorization requirements
New behavioral health Medicare Advantage provider fax beginning March 30, 2020
Prior authorization requirements: new 2020 codes for coverage and precertification
New specialty pharmacy network for Amerigroup
Provider orientation webinar schedule 2020
November 2019 Medical Policies and Clinical Utilization Management Guidelines Update
MMP — Prior authorization requirements: new 2020 codes for coverage and precertification
Medicare Advantage — Prior authorization requirements: new 2020 codes for coverage and precertification
Clinical Criteria Web Posting December 2019
New Training Opportunities: Centralized Training Infrastructure for Evidence Based Practices
MMP Clinical Criteria Web Posting December 2019
Medicare Advantage Clinical Criteria Web Posting December 2019
MMP — New Medicare Advantage Opioid Treatment Program benefit
MMP Clinical Criteria Web Posting November 2019
Medicare Advantage — November 2019 Medical Policies and Clinical Utilization Management Guidelines update
MMP — November 2019 Medical Policies and Clinical Utilization Management Guidelines update
New Medicare Advantage Opioid Treatment Program benefit
Medicare Advantage — Coding tip for psychological and neuropsychological testing
New telemedicine and telehealth requirements
Medicare Advantage Clinical Criteria Web Posting November 2019
Clinical Criteria Web Posting November 2019
Incorrect Claims Payments Alert
Update on Personal Home Helper supplemental benefit for Medicare Advantage Members
Nursing facility and sleep center reimbursement
Procedures for submitting referrals for Medicare Advantage meal benefits requiring precertification
Long-term services and supports provider update
Benefits update for Special Supplemental Benefits for the Chronically Ill
Revision to evaluation and management services — over-coded services postponed
Medicare Advantage — Everyday Extras — personal home helper
Prior authorization requirements for CardioMEMS
Medicare Advantage — Outpatient Rehabilitation Program transition: new prior authorization requirements
Introducing two new Amerigroup Amerivantage (Medicare Advantage) Special Needs Plans for 2020 in Texas
New CMS requirement: Hospitals must use Medicare Outpatient Observation Notice
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update
MMP Modifier 62: Co-Surgeons Reimbursement Policy Update
Medicare Advantage Personal Home Helper benefits
Expansion of Specialty Pharmacy Precertification List: Zirabev
2020 Medicare risk adjustment provider trainings
Introducing two new Medicare Advantage special needs plans for 2020
InterQual 2019.1 update
Multiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update
MMP Multiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update
New Specialty Part B Preferred Device — Effective January 17, 2020
Medicare New Specialty Pharmacy Medical Step Therapy Requirements — Effective January 17, 2020
MMP Pharmacy Benefit Manager Change to IngenioRx — Effective 1/1/2020
Healthcare Quality Patient Assessment Form and Patient Assessment Form
Medicare Advantage- Healthcare Quality Patient Assessment Form and Patient Assessment Form
Improving the Patient Experience – CME
MMP — August 2019 Medical Policies and Clinical Utilization Management Guidelines Update
MMP — Clinical Criteria Web Posting September 2019
Medicare Advantage — Clinical Criteria Web Posting September 2019
Clinical Criteria Web Posting September 2019
August 2019 Medical Policies and Clinical Utilization Management Guidelines Update
DSHS Laboratory Web Portal Not Available Notice
MMP — Clinical Criteria Web Posting August 2019
Clinical Criteria Web Posting August 2019
TX 2020 Medicare Advantage plan changes
Prior authorization requirements for E0784, K0553 and K0554
Specialty pharmacy precertification list
Medicare Advantage — August 2019 Medical Policies and Clinical UM Guidelines update
Reminder to Medicare Advantage Providers- Refer In-Network
Provider training series
MMP-Prior authorization requirements for E0784, K0553 and K0554
Medicaid — Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
MMP CMS reminder: expedited/urgent requests
Medicare Advantage — CMS reminder: expedited/urgent requests
Congenital Syphilis Health Advisory
MMP-Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Medicare Advantage — Aspire Telehealth Palliative Care Program bulletin
MMP Aspire Telehealth Palliative Care Prgm bulletin
MMP Rehabilitative services prior authorization review update
Rehabilitative services prior authorization review update
Medicare Advantage — June 2019 Medical Policies and Clinical UM Guidelines update
Prior Auth Q2 2019 Medicare CoC Rule Changes-AGP
Obstetric delivery diagnosis requirements changes
2019 Enhanced Personal Health Care Program releases myFHR
Public Health Notice About Severe Lung Disease Among Persons Who Report Vaping
Tobacco Cessation Benefits in Medicaid & CHIP
Medicare Advantage — Medicare Preferred Cont Glucose Monitors
MMP Drug Screen Testing Update
March 2019 Clinical Utilization Management Guidelines
Guidelines update for therapy precertification requests
Clinical Criteria Web Posting July 2019
Pharmacy benefit manager change to IngenioRx
MMP Medical Policies and Clinical UM Guidelines update
Medicare Advantage — 2019 Risk Adjustment Provider Trainings
Drug Screen Testing Update
March 2019 Medical Policies and Clinical Utilization Management Guidelines Update
June 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Prior authorization requirements changes effective November 1, 2019
MMP Clinical Criteria Web Posting Q2 2019
MMP Clinical Criteria Web Posting Q1 2019
MMP Clinical Criteria Updates
Authorizations related to Long-Term Services and Supports Billing Matrix updates
Assisting your patients in managing the Donut Hole
Lowering health risks with no-cost statins
MMP Changes to PA requirements
Prior authorization requirements for continuous positive airway pressure supplies
Medicare Advantage – January 2019 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – March 2019 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – CLIA for Amerigroup
Medicare Advantage – Pharmacy benefit manager change to IngenioRx
Clinical Criteria Web Posting Q1 2019
STAR+PLUS long-term services and supports provider update
Clinical Laboratory Improvement Amendments
Semi-Annual Cost of Care Review
Medicare Advantage- AGP Customization for IP Cancer Therapy
Customization for IP Cancer Therapy
Evaluation and management services -over-coded services
Texas Medicare: IntegraNet, Gonzaba, Prospect and Great States Health independent physician association collaboration
MMP — Hearing Care Solutions began service June 6, 2019
Clinical Criteria Web Posting Q2 2019
Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy
Medicare Advantage – Clinical Criteria Web Posting Q2 2019
Beacon Health Options
January 2019 Medical Policies and Clinical Utilization Management Guidelines Update
OBGYN Ultrasound Update
Behavioral health prior authorization reminder regarding ambulatory and residential detoxification
Medicare Advantage — Prior Authorization Requirements for Erelzi, Amjevita, Voretigene neparvovec, Nanacog and Lartruvo
Case Management Referral Form
Unspecified Diagnosis Code Update
Deactivated NCCI MUE Limitations for Substance Use Disorder Treatment and Breast Pump Replacement Parts
Prepayment clinical validation review process
Upgrade to 23rd Edition of MCG Care Guidelines
Span of coverage information
MMP Prior authorization requirements for Part B drug Evomela
Updated Limitation for Zika Virus Testing Effective July 1, 2019
Delegated Psychological Services to Allow More Than One Modifier on the Same Date of Service Effective July 1, 2019
Tobacco Use Cessation Services Provided in a Group Setting
Update to Emergency Department: Level of E&M Services Reimbursement Policy (Medicare-Advantage Only)
Medicare Advantage – Outpatient Rehabilitation Program transitioning to AIM
MMP Outpatient Rehabilitation Program transitioning to AIM
2019 Texas Pay for Quality Provider Incentive Plan
MMP Submitting corrected claims
MMP Partial hospitalization services
Medicare Advantage – Medical records request for risk adjustment
Update: Medicare Advantage – 2019 risk adjustment provider trainings
MMP Medical records request for risk adjustment
2019 Utilization Management Affirmative Statement concerning utilization management decisions
MMP-2019 Utilization Management Affirmative Statement concerning utilization management decisions
Medicare Advantage – Partial hospitalization services
Medicare Advantage – Fall prevention tips
Revision to Facility Emergency Department reimbursement policy postponed
Smoking and Tobacco Use Cessation Counseling Benefits to Change for Texas Medicaid on May 1, 2019
Sports physicals and annual checkups
Prior authorization update for physician order requirements
Medicare Advantage – AIM cardiology and radiation oncology guidelines
Medicare Advantage – Prior authorization requirements for DME repair and portable oxygen concentrator
MMP Prior authorization requirements for DME repair and portable oxygen concentrator
MMP Update: evaluation and management with Modifier 25
Medicare Advantage – Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage — Update: 2019 Risk Adjustment provider trainings
November 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Alert — EVV Tool Kit Module Two
Module Two — EVV Roles and Responsibilities Part 1 of 2
Clinical Criteria updates
Medicare Advantage – Change to 835 ERA for all D-SNP MA members for 2019
Medicare Advantage – Special Need Plans training required
Medicare Advantage – Clinical criteria updates for specialty pharmacy
Medicare Advantage – Amerigroup eye refraction and routine eye exam billing information
Medicare Advantage – Pharmacy and Therapeutic Committee updates
Changes to outpatient BH PA requirements
Wound care treatment request update
Guidelines for communications between providers
MMP — New specialty Medicare Part B device Voluntary Steerage Program
Medical necessity review for appropriate level of care
Enhanced claim payment dispute process
Medicare Advantage – Member Explanation of Benefits redesigned
Medicare Advantage – New specialty Part B device Voluntary Steerage program
Medicare Advantage – 2019 Risk Adjustment Training
September 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Electronic data interchange gateway update
July 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Therapy services monitoring
Medicare Advantage – 2019 Annual Notice of Change
Prior authorization requirements for Sublocade
Alert — Texas Credentialing Alliance & CVO Reminder about CVO Process & Availity Portal
Prior authorization requirements for Subcutaneous Implantable Defibrillator system
MMP Transition of back pain management and cardiology utilization management programs from OrthoNet to AIM
Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
Online registration processes for electronic remittance advices and electronic funds transfers
Effective September 1, 2018, Amerigroup has transitioned into a strategic relationship with Availity
Accessing Remittance Inquiry
Remittance Inquiry Tool Now Available
Alert — Texas Credentialing Verification Organization
Guidelines update for processing therapy precertification requests
Medicare Advantage – Genetic testing prior authorization by ordering physician helps ensure accurate lab payment
Medicare Advantage – Amerigroup transitions back pain management and cardiology UM programs from OrthoNet to AIM
Medicare Advantage – Please evaluate statin use for MA members with diabetes, cardiovascular disease
Medicare Advantage – Medicare pharmacy and prescriber home starts January 2019
TX MMP Prior authorization requirements for Part B drug Nivestym
Medicare Advantage – Prior authorization requirements for Part B drugs: Nivestym
MMP Prior authorization requirements for high-level, definitive drug
New pharmacy electronic prior authorization request tool (ePA) through CoverMyMeds
Neonatal Level of Care Designation Required
Prior authorization requirements for high-level, definitive drug testing
New pharmacy prior authorization retail fax number
TX MMP Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila
Prior authorization requirements for Interferon beta-1a
Prior authorization requirements for Somatrem
Medicare Advantage – Prior authorization requirements for high level definitive Drug Testing(s)
MMP Inpatient Readmissions reimbursement policy update
Medicare Advantage – myNEXUS Home Health Care Program for Utilization Management, Network Contracting and Claims Processing FAQ
Medicare Advantage – Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila
Neonatal Level of Care Designation Required for Hospital Providers Rendering Neonatal Inpatient Services
Medicare Advantage CMS issues regulatory changes for short- and long-acting narcotics; days’ supply limits effective Jan. 1, 2019
Medicare Advantage – DME providers and physicians: important wheelchair prior authorization information
Medicare Advantage – Submit PA medication requests electronically; new phone number for MA prescription Pas effective Sept. 1
Medicare Advantage – Members receive incentives for completing screenings
Medicare Advantage – Amerigroup adopts Milliman Care Guidelines for inpatient rehabilitation, subacute rehabilitation and skilled nursing facility clinical reviews
May 2018 Medical Policies and Clinical Utilization Management Guidelines Update
MMP Prior authorization requirements for Azedra and Poteligeo
January 2018 Medical Policies and Clinical Utilization Management Guidelines Updates
March 2018 Medical Policies and Clinical Utilization Management Guidelines Updates
MMP Prior authorization requirements for Part B drugs: Retacrit, Damoctocog and Ilumya
Medicare Advantage – Inpatient Readmissions Medicare Advantage Update
Medicare Advantage – Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – Prior authorization requirements for Part B drugs Retacrit, Damoctocog and Ilumya
Amerigroup opioid analgesics utilization management clinical policies
Medicare Advantage – MyDiversePatients.com
Prenatal and postpartum outreach initiatives
Non-emergency ambulance prior authorization update
Medicare Advantage – Medical Policies Update
Prior authorization requirements for Cabazitaxel
Postpartum placement of long-acting reversible contraception
Medicare Advantage – Prior authorization requirements for Part B drugs: Azedra and Poteligeo
MMP Prenatal and postpartum outreach initiatives
Medicare Advantage – Peer-to-Peer Process
Medicare Advantage – Home Health network to be delegated to myNEXUS
Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)
MMP Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
Services requiring prior authorization
Lower extremity vascular intervention codes require prior authorization
MMP Prior authorization requirement for Part B drug: Trelstar
Prior authorization requirements for Darzalex drug
CHIP copay changes
MMP Prior authorization requirements for cardiovascular services
Medicare Advantage – Cologuard covered for Medicare Advantage members
Electrical stimulation device to require prior authorization
MMP Electrical stimulation device to require prior authorization
Medicare Advantage – Prior authorization requirements for Cardiovascular Services
MMP Prior authorization requirements for Part B drugs: ZEVALIN and Eptacog
Medicare Advantage – CMS Selects Amerigroup for 2016 National RADV Audit
Medicare Advantage – Prior authorization requirement for Electrical Stimulation Device
Medicare Advantage – Prior authorization requirements for part B drugs: Zevalin and Eptacog
Medicare Advantage – Prior authorization requirements for part B drug: Trelstar
MMP New Original Medicare ID Cards on the Way
New Texas Credentialing Verification Organization coming April 1, 2018
New Texas Credentialing Verification Organization coming April 1, 2018 for Amerigroup STAR+PLUS MMP
Prior authorization requirement update for Mylotarg
Medicare Advantage – myNexus Network Contracting FAQ
Q4 Medical Policies and Clinical Utilization Management Guidelines Updates
Medicare Advantage – Utilization management decisions based on appropriateness of care, benefits
Medicare Advantage – Prior authorization requirements for CAR-T Therapy
Medicare Advantage – Amerigroup to conduct post-payment reviews of distinct procedural services modifiers
MMP Prior authorization requirements for Part B drugs: Mylotarg and Mvasi
MMP Prior Authorization for: Brineura, Tremfya and Zinplava
AIM Musculoskeletal Guidelines Notice
MMP 2018 Utilization Management Affirmative Statement
HHSC Credentialing Verification Organization (CVO) Provider FAQ
HHSC Credentialing Verification Organization (CVO) Provider Notification Scheduled Webinar
HHSC Credentialing Verification Organization (CVO) Provider Notification
STAR Kids Clinical and Administrative Advisory Committees
TAHP Credentialing Verification Organization Information
Medicare Advantage – Prior authorization requirements for part B drugs: Mylotarg and Mvasi
Medical Policy update — Hyaluronan Injections
Eight injectable drugs will require prior authorization
MMP Prior Authorization for: Varubi and Fasenra
MMP Prior Authorization for: Rebinyn, Fibryna and Hemlibra
Overpayment identification and refund requirements
Elotuzumab to require prior authorization
Medicare Advantage – Prior authorization requirements for injectable drugs: Brineura, Tremfya and Zinplava
Medicare Advantage – Prior authorization requirements for Part B drugs: Rebinyn, Fibryna and Hemlibra
Medicare Advantage – Imaging Services Providers Must Complete OptiNet Assessments to Avoid Line-item Denials
Medicare Advantage – Prior authorization requirements for part B drugs Varubi and Fasenra
Q3 Medical Policies and Clinical Utilization Management Guidelines Updates
Update to precertification requirements for radiation oncology, sleep medicine and cardiology services
Consolidated Credentialing Verification Organization (CVO) Initiative
Credentialing Verification Organization (CVO) Provider FAQ
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
New prior authorization requirements for clinician-administered drugs Exondys and Kymariah
MMP New pharmacy prior authorization fax number effective January 1, 2018
MMP New medication electronic prior authorization request tool effective January 1, 2018
MMP Prior authorization requirements for Part B drugs Besponsa and Vyxeos
Medicare Advantage – New Original Medicare ID Cards on the Way
Medicare Advantage – Amerigroup tiers SNF network
Medicare Advantage – Change to the ERA for all who are enrolled in a Special Needs Plan
Medicare Advantage – Change to the ERA for all who are enrolled in a Special Needs Plan
Medicare Advantage – Additional hypertension drugs available at $0 copay
Medicare Advantage – 2018 Annual Notice of Change
Medicare Advantage – Prior authorization requirements for Part B: Aliqopa, Cinvanti and Opsiria
Moving Towards Equity in Asthma Care- Continuing Medical Education Credit Opportunity
New Medicaid member appeals process changes effective September 1, 2017
Medicare Advantage – Prior authorization requirements for part B drugs: Besponsa and Vyxeos
MMP Prior Authorization requirements for Part B Drugs Aliqopa, Cinvanti, and Opsiria
Required prior authorization for genetic testing effective December 15, 2017
Medicare Advantage – Coordination of Benefits Update
Medicare Advantage – Members Should Use NationsHearing
Medicare Advantage – Network Delegation for Home Health Care Services
Medicare Advantage – Critical Access Hospitals (CAH) Reimbursed at Medicare Rate
Medicare Advantage – Include NPI on Surgical Procedure UB04 Bills
Medicare Advantage – Members to Receive Gift Cards Diabetic Retinal Eye Exams
Medicare Advantage – Help Ensure Medicare Part D Members Receive a Comprehensive Medication Review
Medicare Advantage – Prior Authorization for part B drugs Renflexis, Rituxan Hyclea, and Zilretta
EVV and Hurricane Harvey
EVV FAQs Hurricane Harvey
Updated Medicaid/CHIP Provider Manual
New review process for not otherwise classified drug codes
MMP Prior authorization requirements for Part B drugs: Renflexis (infliximab-abda),Rituxan Hyclea (rituximab/hyaluronidase) and Zilretta (triamcinolone acetonide SR)
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Include National Provider Identifier on surgical procedure UB04 bills-MMP
Register Now for EVV Provider Stakeholder Meetings
Medicare Advantage – Prior Authorization Requirement Change for Orthotics
Update to ordering/prescribing/referring claim submissions
Clinician administered drug requirements for RhoGam
Private Duty Nursing versus Skilled Nursing PCP Toolkit
STAR Kids LTSS Provider Update
Emergency Prescription Guidelines for Schedule II Medications
Orthotics to require prior authorization
Medicare Advantage – Noncovered Services FAQs
New therapy prior authorization request form
Q2 Medical Policies and Clinical Utilization Management Guidelines update
Medicare Advantage – Prior Authorization for Genetic Testing for Members Effective Nov. 1
Attendant Compensation Enhancement Program open enrollment
AAPCA and MBCC programs managed care expansions
El Paso Children’s Hospital announcement
MMP Prior authorization requirements for Part B drug: Imfinzi (durvalumab)
MMP Prior authorization requirements for Part B drug: Yondelis (trabectedin)
Medicare Advantage – Prior authorization requirement change for part B drug Yondelis
THSteps Therapeutic Dental Benefits to Change for Texas Medicaid July 1, 2017
Medicare Advantage – Prior authorization requirement change for part B drug Imfinzi
STAR+PLUS long-term services and supports update
Hemophilia factor injections to require prior authorization
Medicare Advantage — Modifier FX and Reimbursement Policy Update
MMP — Modifier FX and Reimbursement Policy Update
CHIP Providers Must Complete Enrollment by December 31, 2017
Medicare Advantage — Submitting Corrected Claims
Medicare Advantage — Bill CLIA Certification for Claims
Medicare Advantage — HCPC Codes Allow for Payment for Coordinating Behavioral Health Services
Medicare Advantage — MRP Billing Codes for Reimbursement
Medicare Advantage — Access Patient360 for your patient records directly through the Availity Web Portal
Wheelchair component or accessory, not otherwise specified to require prior authorization
Q1 Medical Policies and Clinical Utilization Management Guidelines update
Update regarding appointment availability standards
Radiation oncology, sleep medicine and cardiology services for STAR and STAR+PLUS members 21 and older
MMP Prior authorization requirements for the Part B injectable/infusible drug Exondys 51 (eteplirsen)
Spinraza Prior Authorization and Billing Requirements
Miscellaneous wheelchair code precertification update
MMP Update to the ClaimsCheck® upgrade to ClaimsXten™
Appointment Availability and After-Hours Access Requirements
Medicare Advantage — Inpatient Readmissions Update
MMP — Inpatient Readmissions Update
Pain Management Request Update
Medicare Advantage — Amerivantage ESRD (HMO-POS SNP) offers benefits designed for ESRD patients
MMP High-Risk Medication Report
MMP Prior authorization required for continuous interstitial glucose monitoring
Medicare Advantage — AccordantCare™ to provide support for members with HIV
Medicare Advantage — New Coding Guidelines for 3D Mammography
Medicare Advantage — Coding Patient Services Reminders
Medicare Advantage — Comply with Clinical Information Requests
Medicare Advantage — New G Codes for Home Health Agencies
Medicare Advantage — AIM OptiNet Imaging Services Initiative Postponed
Medicare Advantage — New Place of Service Code 02 for Telehealth Services
Medicare Advantage — Preventive Service Procedure Codes updated for 2017
Medicare Advantage — Review High-Risk Medication Reports
Medicare Advantage — CMS Selects Amerigroup for 2015 National RADV Audit
Medicare Advantage — Prior Authorization Requirements for Part B Drug — Exondys 51
Medicare Advantage — Prior Authorization Requirements for Part B Drug — Evomela
Medicare Advantage – AIM OptiNet Registration FAQ
NEMT Form Update
Level two and level three shower chairs to require prior authorization
Medicare Advantage — Complete your AIM OptiNet® registration services by April 1, 2017
Universal billing claim requirement clarification
MMP Epidermal Growth Factor Receptor Testing with the attached
Part B Drug Evomela MMP Green
Medicare Advantage — CMS Emergency Preparedness Rule
Behavioral Health Authorization Clarifications
MMP Behavioral Health Authorization Clarifications
Medicare Advantage — HEDIS Measure: Ensure Medication Reconciliation is Completed after Discharge
MMP Additional information on ClaimCheck®* upgrade to ClaimsXten™*
Medicare Advantage — Behavioral Health Authorization Clarifications
Medicare Advantage — Radiation Therapy Services – Contact AIM for Delivery, Amerigroup for Planning
Medicare Advantage — Transitional Care Management (TCM) Services
Medicare Additional information on ClaimCheck® upgrade to ClaimsXten™
Medicare Advantage — Retrospective Medical Record Review Program Launches
Medicare Advantage — Members Should Use Hearing Care Solutions
Medicare Advantage — Claims for Tetanus Vaccinations
Medicare Advantage — Payment Reduction for X-rays Taken Using Film
Genetic testing services to require prior authorization
Additional information on ClaimCheck® upgrade to ClaimsXten™
MMP Epidermal Growth Factor Receptor Testing
Q4 Medical Policies and Clinical Utilization Management Guidelines update
Clarification on medical director peer-to-peer process
MMP AIM Radiation Oncology Program
Medicare Advantage — Additional Information on ClaimCheck Upgrade to ClaimsXten
Medicare Advantage — AIM OptiNet Imaging Services Initiative Postponed
Notification process reminder
Miscellaneous durable medical equipment billing guidelines
Hospital observation service limits MMP
Medicare Advantage — Prior Authorization Requirement Change to Epidermal Growth Factor Receptor Testing
Medicare Hospital observation service limits
Medicare Advantage — Hospitals must use Medicare Outpatient Observation Notice
MMP Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Prior authorization requirements for new injectable/infusible drugs: Istodax (romidepsin), Ixempra (ixabepilone), Doxil (doxorubicin), Torisel (temsirolimus) and Inflectra (infliximab-dyyb)
Continuous interstitial glucose monitoring to require prior authorization
Intracardiac electrophysiological studies and catheter ablation to require prior authorization
Medicare Advantage — DEN Program Helps Members Better Manage Diabetes
MMP Continuous interstitial glucose monitoring to require prior authorization
MMP New Injectable Infusible Drugs: Erelzi (etanercept), Amjevita (adalimumab), Voretigene neparvovec, Nanacog (recombinant factor IX) and Lartruvo (olaratumab)
Medicare Advantage — Prior Authorization Requirements for Cuvitru, Ocrevus and Lutathera
Q3 Medical Policies and Clinical Utilization Management Guidelines update
MMP Prior authorization requirement change for Torisel® (temsirolimus)
Prior authorization requirements for new injectable/infusible drugs: Darzalex (daratumumab) and Empliciti (elotuzumab)
Medicare Advantage — Prior Authorization Requirements for Continuous Interstitial Glucose Monitoring
MMP Elective one and two vessel coronary artery bypass graft to require prior authorization
Elective one and two vessel coronary artery bypass graft to require prior authorization
MMP New Injectable Infusible Drugs: interferon gamma-1b (Actimmune®), mecasermin (Increlex®) and azacitidine (Vidaza®)
MMP New Injectable Infusible Drugs: Doxil (doxorubicin) and Sustol (granisetron)
Clarification of Arterial Codes 10 Day Rule
MMP Prior authorization requirements for new injectable/infusible drugs: Inflectra (infliximab-dyyb) and Cinqair (reslizumab)
MMP New Injectable Infusible Drugs — Emend (fosaprepitant), Aloxi (palonosetron) and Afstyla (antihemophilic)
Medicare Advantage — Recommended Skilled Nursing Providers
2016 Q2 Medical policies and Clinical Utilization Management (UM) Guidelines
MMP New Injectable Infusible Drugs Istodax, Ixempre and Taltz
Medicare Advantage — Clinical Cumulative Morphine Equivalent Dosing Point of Sale Edit effective January 1, 2017
Medicare Advantage — Assisting Members with Rheumatoid Arthritis Who May Be Missing Important Medications
Medicare Advantage — In-Home Bone Mineral Density Testing
Medicare Advantage – In Home Visits Available for Members with Chronic and Complex Conditions
Effective November 1, 2016 ClaimsCheck® upgrade to ClaimsXten™
Precertification update for vascular embolization or occlusion services
MMP — Precertification update for vascular embolization or occlusion services
Precertification requirements for knee and spinal orthoses
Texas Medicaid Re-Enrollment Reminder
Postpartum long-acting, reversible contraception benefit now available
Primary care provider change form now available
Medicare Advantage — Dual Advantage Simple Billing Tips
Precertification for knee and spine orthoses effective July 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
Medical policies update
Medicare Advantage — CMS Selects Amerigroup for 2014 National RADV Audit
Medicare Advantage — UPDATED: Imaging Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage — New Prior Authorization Requirements Effective May 1, 2016
Medicare Advantage — Member Incentive for Wellness Visit
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
Precertification for knee arthroscopy effective April 1, 2016
Precertification for knee and hip arthroplasty effective May 1, 2016
Custom molded orthotics precertification
Medicare Advantage – SELECT product
Medicare Advantage — Radiation Therapy: Select Brachytherapy, IMRT CPT Codes to Require Prior Authorization
MMP: Addition to Part B injectibles/infusibles effective January 1, 2016
Medicare Advantage — 2016 Plan Changes
Hemophilia Drugs Authorization Update Effective December 15, 2015
Home Health Therapy Codes Update Effective November 15, 2015
Q3 Medical Policies and Clinical Utilization Management Guidelines Update
Cervical Length Screening Guidelines
Precertification for Part B Drugs Entyvio and Cyramza
Medicare Advantage — House Call Program
Medicare Advantage — Post Service Drug Claim Edits Updated
Medicare Advantage — DSNP Training Invite
Medicare Advantage — 2015 Specialty Rx Plan Changes to Claims Payment
Medicare Advantage — New Precertification Requirements Effective September 1, 2015
DME Provider Orientation Webinar Schedule and Invite​
Amerigroup Changes PBM to Express Scripts Starting June 1
Q1 Medical Policies and Clinical Utilization Management Guidelines Update
Reminder: Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) is live!
Medicare Advantage — Part B Drug Reminder
Medicare Advantage — Precertification Required for Hemophilia Drugs
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
Medicare Advantage: Precertification Required on Four New Part B Injectables
Encourage Medicare Advantage Members to Stay Up-to-Date on Preventive Care
Medicare Advantage — 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 Community Care, Optum Collaborating To Ensure Members Receive Regular Exams, Preventive Screenings
Medicare Advantage: OrthoNet to Conduct Medical Necessity Reviews, Professional Service Coding Reviews
New 2015 Medicare Advantage precertification fax number for skilled nursing, long term acute care and inpatient rehab
Medicare Amerivantage PBM Conversion
Medicare Advantage: Provider Requirements and Medicare Notices
New Federally Qualified Health Center Billing Guidelines in Effect for Original Medicare
Flu Vaccinations
Service Area Change Fax
Medicare Advantage Peer to Peer Changes
Inpatient Readmissions
Encourage Exercise to Prevent Falls
Postponed: Upcoming Disbursement Process Changes
Upcoming changes to durable medical equipment precertification requirements
Availity Announcement and Frequently Asked Questions
HIPPS Codes Required for All Skilled Nursing and Home Health Providers
Bone Density Testing for Medicare Members
Medicare Advantage Members to Receive Monthly Summary Statements
Upcoming Changes to Amerivantage (Medicare Advantage) Precertification Requirements
El Paso Lubbock Medicare Advantage Product Highlights Provider Letter
Dallas Ft. Worth Medicare Advantage Product Highlights Provider Letter
San Antonio Medicare Advantage Product Highlights Provider Letter
Houston Medicare Advantage Product Highlights Provider Letter
Medicare Requirements for Outpatient Therapy Claims
Medication Precertification Tool Available Now
The New Electronic Health Risk Assessment Form
HEDIS Requirements for DMARD Therapy for Rheumatoid Arthritis
Precertification Appeals Tool Coming Soon
Online Claims Appeal Tool Coming Soon
The Medicare Health Outcomes Survey
CMS fact sheets about the rate increase for primary care providers
Assess and strengthen your cultural competency
Hurricane Harvey: CHIPS copayment notice
Hurricane Harvey: Disability Resources
Hurricane Harvey – DSHS Lab Specimens
Louisiana Providers Servicing TX Medicaid-CHIP Members
Medicare Advantage — Assisting Members with Rheumatoid Arthritis Who May Be Missing Important Medications
Medicare Advantage — Amerigroup eye refraction and routine eye exam billing information
Medicare Advantage — Complete OptiNet Assessments for Out-of-State Office Locations; Drop Down Menu Changed
Medicare Advantage — Facility Global Surgical Package Billing Policy updated effective Jan. 1, 2018
Medicare Advantage — Liability Assignment for Eye Refraction and Self-Administered Drugs
Medicare Advantage — 2015 Retrospective Medical Record Review Program
Medicare Advantage — New 2016 prior authorization requirements effective January 1, 2016
Medicare Advantage — Imaging Site Scores for Outpatient Diagnostic Imaging Could Impact Reimbursement
Medicare Advantage — Amerigroup Follows CMS Guidelines for DME CustomizationÂ
Medicare Advantage — Billing Requirements for TAVR and TMVR
Medicare Advantage — Avastin for Ophthalmic Use
Medicare Advantage — Avoid Denials of Diagnostic Claims by Completing Item 20 (CMS 1500) Correctly
Medicare Advantage — Prior Authorization requirements for Continuous Interstitial Glucose Monitoring
Medicare Advantage — Diabetic Supply Changes for 2016
Medicare Advantage — Amerigroup Encourages High-Risk Members to get a Flu Shot
Medicare Advantage — House Call Program
Medicare Advantage — Register for Imaging Site Scores by March 1, 2016, to Avoid Unnecessary Line-Item Denials
Medicare Advantage — More $0 Copay Medication Available to Members with Chronic Conditions
Medicare Advantage — Part B Updates for Praluent, Repatha and Sylvant
Medicare Advantage — Precertification Required on Part B New Injectables
Medicare Advantage — Participating Providers: Bill Medicare Part D for Shingles or Tetanus Vaccination Claims
Medicare Advantage — Required Billing Updates for Rural Health Clinics: HCPCS Codes Required for all RHC Claims
Medicare Advantage — Routine Physical Exams are Covered in 2017
Medicare Advantage — Precertification update for scoliosis and spine deformity
CMS 1500 Update
2014 Texas Appointment Availability & After-Hours Access Requirements Webinar
Provider Bulletin 2014, Issue 1
Provider Bulletin 2014, Issue 3
2015 Dallas/Tarrant and MRSA Webinar Training Schedule
2014 Texas Appointment Availability & After-Hours Access Requirements Webinar
MMP — AIM Radiation Oncology Phase I
2016 Provider Orientation Webinar Schedule
2016 Texas Health Steps Provider Training Webinar Schedule
Nonemergent Ambulance Transportation Authorizations
Changes to EVV Vendor System Effective 06.01.19
Correction to 2015 provider update regarding the revised process for medically necessary reviews
DMEPOS Fee Schedule Notice
Elsevier Performance Manager Provider Registration
Electronic Visit Verification Provider Training
EVV provider webinar training schedule
Small Alternative Device Zip Tie Policy Change
Electronic visit verification (EVV) initiative
October 2017 HHSC EVV Reason Code Scenarios
HHSC EVV Reason Code Scenarios Answer Key
EVV Revises Unallowable Phone Identification and Recoupment Policy
EVV Visit Transaction Validation Enhancements Effective 06.01.19
Pharmacy Prior Authorization Presentation
Fee Schedule Notice
Amerigroup Texas Fee Schedule
HHSC Assisted Living Living Facility and Adult Foster Care Survey Letter
Electronic Visit Verification(EVV)Provider Stakeholder Meeting
Interim Hospital Inpatient Claim Processing
Incontinence Supplier Change
Long-term Services and Supports Orientation
Long Term Care provider orientation webinar training schedule
Prior authorization and claim billing changes for 17P therapy
NDC Claims Processing Update
Nursing Facility Training Schedule
Nursing Facility Provider Billing Reminders and Updates
Nursing Facility Training Schedule
Revised process for medical necessity reviews for therapy and spine and back pain management
Patient Protection and Affordable Care Act Deadline has Passed
Prior authorization required for drugs Entyvio and Cyramza
Coding Spotlight — Pregnancy
Primary Care NAS/NOWS Provider Toolkit
Provider Advisory Group meeting schedule
Update on Targeted Case Management and Mental Health Rehab Services in the Dallas SDA
Hemophilia factor injections to require prior authorization
Hurricane Harvey Emergency Preparedness Notice Learn More
Provider Payment Dispute and Claim Correspondence Submission Form
Notice to out-of-network STAR Kids providers
Updates for Processing Therapy Precertification Requests
2016 Quality Improvement Summary
Providers must re-enroll to be paid for Medicaid (STAR or STAR+PLUS) services
Reminder: All providers must re-enroll in Texas Medicaid by March, 2016
Final notice to continue receiving Medicaid payments
STAR Kids BH Provider Training Schedule
STAR Kids Provider Manual
Provider Orientation
Physical, occupational and speech therapy authorization requirements
Revised Process For Medical Necessity Reviews For Therapy And Spine And Back Pain Management
Reminder: Texas Health Steps requirements
Transitioning Providers: EVV Claims May be Denied or Recouped
Universal billing claim requirements using type of bill and patient status 30
Targeted Case Management and Mental Health Rehab Services
Community First Choice
MMP- AIM Radiation Oncology Update
MMP Prior authorization for outpatient radiation therapy services
Transition to DataLogic Timeline
Transitioning to DataLogic Information Session Schedule
EVV Cell Phone Policy Alert
Electronic Visit Verification coming to Amerigroup!
MEDsys Providers — Key Dates, Transition Instructions and Frequently Asked Questions
Maternity Services Reimbursement Policy Update
Updated Medicaid/CHIP Provider Manual available online
Updated Information on Targeted Case Management and Mental Health Rehab Services
Help Us Locate Children of Farmworkers
Additional radiation oncology prior authorizations (PA) should be directed to AIM Specialty Health® (AIM) effective July 15, 2016
MMP Medical Injectables Prior Authorization Form
Nursing Facility Provider Update — MMP
MMP: Behavioral Health: Authorization Changes Effective October 1, 2015
MMP: New Prior Authorization Form Coming September 1, 2015
MMP — Additional radiation oncology prior authorizations should be directed to AIM Specialty Health® (AIM) effective July 1, 2016
MMP — Radiation therapy: select Brachytherapy, IMRT CPT codes to require prior authorization
Nonemergent Transportation Update
Newborn Diagnostic Related Group Precertification and Claims Processing
Nursing Facility 2016 Provider Orientation Webinar Schedule
Nursing Facility Provider Update — Medicaid
Federal nondiscrimination and accessibility update.
Nonemergency ambulance prior authorization update
Effective July 21: Update to Requirements for Ordering or Referring Claim Submissions
Update to Requirements for Obstetric Delivery Claims and Diagnosis Codes
OrthoNet Announcement and FAQ
2015 Texas Pay for Quality Provider Incentive Plan
Patient360 Lets You Access Member Records in a Few Clicks
PCP Rate Increase Decommissioning Bulletin
Provider Manual Update: PPR and PPC Information
Update: Certain drugs to require prior authorization
Now Available Online: Updated Medicaid/CHIP Provider Manual
Retroactive TPI Assignment and the Claims Process: Update
TX Network Improvement Program
IMPORTANT Revision to MEDsys — Issued Small Alternative Devices Return Policy
Visit Maintenance Reduction Solutions
All providers must re-enroll in Texas Medicaid by March 2016

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