Get the latest articles and announcements on Amerigroup policies, clinical/utilization management guideline updates, state and federal regulatory changes, and much more.
Medicaid updates
Early elective delivery new claim edit process
Beginning June 27, 2022, your health plan will be implementing a new early elective delivery (EED) claim submission process, which will capture non-medically necessary EEDs and, at the same time, distinguish uncomplicated spontaneous labor/vaginal deliveries at 37 to 38 weeks’ gestation.
Reminder – Place of service code for professional services in an outpatient setting
We require all services that are rendered in an office, professional building, medical office building, clinic, or a space owned by a hospital or an institutional provider, other than the primary structure on the campus of the hospital or institutional provider, to be billed on a CMS-1500 Claim form. When billing for these professional services on a CMS 1500, they should be billed with place of service (POS) 19 or 22, not POS 11 or 12.
Non-Medicare recognized therapists — billing for dual members
Amerigroup Iowa, Inc. wishes to update and remind our behavioral health (BH) provider network of the importance of including the rendering therapist detail on the CMS-1500 Claims Form when submitting for a member who is dually enrolled with Medicare and Medicaid.
Register today: Exploring the intersection of race and disability
Amerigroup is committed to making healthcare simpler and reducing health disparities. Open discussion about the disability experience for people of color and reducing implicit bias for those in healthcare is critical to improving the health and well-being of the communities in which we live and serve — all Americans.
Updates to AIM Specialty Health Musculoskeletal Clinical Appropriateness Guidelines
Effective for dates of service on and after September 11,2022, the following updates will apply to the AIM Specialty Health (AIM®) Musculoskeletal Clinical Appropriateness Guidelines. As part of the AIM guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable healthcare services.
Medicare updates
Medicare Advantage - Non-Medicare recognized therapists — billing for dual members
Amerigroup Iowa, Inc. wishes to update and remind our behavioral health (BH) provider network of the importance of including the rendering therapist detail on the CMS-1500 Claims Form when submitting for a member who is dually enrolled with Medicare and Medicaid.
Medicare Advantage - MCG Care Guidelines 25th Edition
Effective September 1, 2021, Amerigroup will upgrade to the 25th edition of MCG* care guidelines for the following modules: inpatient and surgical care (ISC), general recovery care (GRC), chronic care (CC), recovery facility care (RFC), and behavioral health care (BHC).
Medicare Advantage - PA Removal Notice for Avastin and its Biosimilars Retraction Notice
In a recent provider bulletin, we advised we would no longer require prior authorization (PA) for the following drugs used to treat ocular conditions, effective May 1, 2021. Please be advised that PA will continue to be required for these drugs.
Medicare Advantage - Clinical Criteria Updates Notification February 2021
On February 19, 2021, and March 4, 2021, the Pharmacy and Therapeutics (P&T) Committee approved the following Clinical Criteria applicable to the medical drug benefit for Amerigroup Iowa, Inc.