Prior Authorization Requirements
Amerigroup Iowa, Inc. accepts prior authorization requests via phone, fax or Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. With ICR, you can submit or check status of a request, attach clinical documentation, and auto-authorize more than 40 common procedures. You may also use Availity’s Maternity Module to report a member’s pregnancy.
Check out our Prior Authorization Lookup Tool to determine prior authorization requirements or contact Provider Services for assistance.
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Behavioral health (Medicaid only)
View Medicaid behavioral health benefits, including prior authorization requirements, on our Behavioral Health page.
Submit a Medicaid behavioral health request
Inpatient fax:
1-844-442-8016
Outpatient fax:
1-844-451-2826
Pharmacy
Be sure to check the applicable formulary before prescribing drugs under the pharmacy benefit for Amerigroup members.
Iowa Medicaid Preferred Drug List (PDL)
Submit a Medicaid pharmacy request
Visit our Pharmacy Information page for detailed information on submitting a pharmacy prior authorization request.
Long-term services and supports (LTSS)
Prior authorization is required for LTSS services. Please refer to the Medicaid Provider Manual or visit our LTSS page for more information.
Submit a Medicaid LTSS request
Fax:
1-800-964-3627
Medicare
Certain Medicare services and procedures require prior authorization from Amerigroup for participating and nonparticipating PCPs and specialists. Refer to the Prior Authorization Lookup Tool or the Medicare Provider Manual for more information.
Submit a Medicare request
Phone:
1-866-805-4589
Fax:
- Home health, durable medical equipment, therapies and discharge planning: 1-888-235-8468
- Concurrent clinical review documentation: 1-888-700-2197
- Behavioral health (inpatient): 1-844-430-1702
- Behavioral health (outpatient): 1-844-430-1703
- Initial admission notifications and all other services: 1-800-964-3627
Related information
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Policies, Guidelines & Manuals
- Referrals
- Forms
- Provider Training Academy
- Pharmacy Information
- Electronic Data Interchange
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