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Case Management Model

Our member-centric case management model integrates behavioral, physical and social factors into each individual member’s plan of care. Case management teams are comprised of nurses, social workers and medical support staff.

Case managers work with members who have high utilization of services, complex medical/behavioral conditions and special health care needs.

Services include

  • Detailed assessments to identify member needs and preferences.
  • Development of member-centric care plans to address needs, gaps in care and disparities.
  • Education on health conditions, medications and value-added benefits.
  • Coordination and collaboration with providers.
  • Connecting members to Social Services.

Hours of operation

Monday-Friday, 8 a.m.-5 p.m. CT

Provider referral process

Submit a referral by using one of the following options:

  • Visit providers.amerigroup.com/TX. Select the Medical Management Model drop-down menu under Provider Resources & Documents. Select Care Management to submit an electronic referral using Provider Care Management Solutions (PCMS).
  • Call Provider Services at 1-800-454-3730.
  • Fax your Case Management Referral Form to:
    • 1-866-249-1180 for OB case management.
    • 1-866-249-1185 for physical heath case management.
    • 1-844-664-7176 for behavioral health case management.

Note: To submit disease management referrals for members with ongoing chronic conditions, select the Disease Management drop-down menu under Provider Resources & Documents and select Disease Management Referral Form.