Provider policies, guidelines & manuals
Amerigroup Community Care is committed to supporting you in providing quality care and services to the members in our network. Here you will find information for assessing coverage options, guidelines for clinical Utilization Management (UM), practice policies and support for delivering benefits to our members.
Provider manual and quick reference cards
The Amerigroup provider manual provides key administrative information, including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies.
- HEDIS Desktop Reference Guide 2023
- Provider Experience QRG
- Centers of Medical Excellence Transplant Operations Manual
- HealthChoice Provider Manual
- HealthChoice QRC
- HEDIS CAT II Coding 2022
- HEDIS Telehealth Coding Bulletin 2022
- HEDIS Well Child/ Immunization 2022
- Inpatient Admission, Concurrent and Retrospective Review Quick Reference Card
- Medicaid QM Desktop Reference Guide
- MY2022 HEDIS Quick Reference Guide - Child
- MY2022 HEDIS Quick Reference Guide - Women and Adult
Medical policies and clinical UM guidelines
Medical policies address the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM Guidelines focus on detailed selection criteria, goal length of stay, and location for generally accepted technologies or services.
Medical policies and clinical UM guidelines
- Clinical Utilization Management Guidelines
- August 2020 Clinical Utilization Management (UM) Guidelines
- November 2020 Clinical Utilization Management (UM) Guidelines
- February 2021 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- November 2021 Clinical Utilization Management (UM) Guidelines
- February 2022 Clinical Utilization Management (UM) Guidelines
Related information
