Prior Authorization Requirements

The Georgia Department of Community Health (DCH) implemented the centralized prior authorization (PA) feature which is the preferred method for submitting preauthorization requests. This feature allows participating Georgia Medicaid providers to submit PA requests to fee-for-service (FFS) and care management organizations (CMOs) through a centralized source: the Georgia Medicaid Management Information System (GAMMIS) .

Alternatively, Amerigroup Community Care is available by phone or via the Interactive Care Reviewer (ICR) 24/7 days a week to accept preauthorization requests. You can access the ICR from the Availity Portal home page.

  • The ICR allows detailed text, photo images and attachments to be submitted along with your request. It also provides a complete view of all utilization management requests with real-time status updates, including email notifications if requested.
  • Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool).
  • To request or check the status of a preauthorization request or decision, log in to Availity. Once logged in, select Patient Management | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

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Preauthorization Contact Information for Amerigroup

Providers and staff can call or fax Amerigroup for help with prior authorization via the following methods:

Provider Services

Hours: Monday to Friday 8 a.m.to 8 p.m., Saturday 10 a.m. to 2 p.m.
 

Phone:

1-800-454-3730

Fax:

1-877-842-7183

Pharmacy

Pharmacy PA requests may be submitted in three ways:

  1. Electronically (i.e., ePA) through www.covermymeds.com
  2. Faxing the completed form to 1-844-490-4736 (for drugs under pharmacy benefit) or to 1-844-490-4870 (for drugs under medical benefit)
  3. Calling Provider Services at 1-800-454-3730

The Medicaid-Approved Preferred Drug List (PDL)  includes information such as mandatory generic requirements, prior authorization (PA), quantity limits, age limits or step therapy.

Pharmacy services billed with the following revenue codes always require prior authorization:

  • 0632 - Pharmacy multiple sources

Behavioral health

  • Inpatient: Submit authorization requests via Availity within 24 hours of a member admitting into the facility or one calendar day of admission.
  • Outpatient: All outpatient prior authorization requests, except for psychological testing, IOP and PHP, should be submitted through the Centralized Authorization Portal on the GAMMIS website. The exception services should be submitted via the Availity Portal.

Behavioral health services billed with the following revenue codes ALWAYS require prior authorization:

  • 0240–0249 - All-inclusive ancillary psychiatric
  • 0901, 0905–0907, 0913, 0917 - Behavioral health treatment services
  • 0944–0945 - Other therapeutic services
  • 0961 - Psychiatric professional fees

Home Health services

  • Prior authorization is required for home health care services. 
  • Covered services include skilled nursing; home health aide; and physical, occupational and speech therapy services, as well as physician-ordered supplies.
  • Services not covered include social services, chore services, Meals on Wheels and audiology services.
  • Providers needing an authorization should call Provider Services at 1-800-454-3730.

Providers needing an authorization should call:

Provider Services

1-800-454-3730

Services billed with the following revenue codes ALWAYS require prior authorization:

  • 0023 - Home health prospective payment system
  • 0570–0572, 0579 - Home health aide
  • 0944–0945 - Other therapeutic services
  • 3101–3109 - Adult day and foster care

Transportation

  • Nonemergency transportation (NET) is covered through the DCH for Medicaid enrollees.
  • No prior authorization or notification is required except for coverage of planned air transportation (airplane or helicopter).
  • Call the 24-hour Nurse HelpLine at 1-800-600-4441 for the Georgia non-emergency transportation (NET) vendor in your region.

24-Hour Nurse HelpLine

Nurse HelpLine

1-800-600-4441

Related resources

  • The Amerigroup Prior Authorization Lookup Tool Online can assist with identifying services requiring prior authorization or determining a code’s prior authorization requirements.
  • You can also refer to the provider manual for information about services that require preauthorization.

Provider tools & resources

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We look forward to working with you to provide quality services to our members.