Amerigroup. An Anthem Company.

New Jersey Providers

Welcome, providers!

Resources that help health care professionals do what they do best — care for our members.

At Amerigroup Community Care, we value you as a provider in our network. That is why we have redesigned the provider site to make it more useful for you and easier to use.

Interested in joining our provider network? We look forward to working with you to provide quality services to our members.

COVID-19 information

Amerigroup is closely monitoring COVID-19 developments and how the novel coronavirus will impact our customers and provider partners.

Availity access

The Availity Portal offers health care professionals free access to real-time information and instant responses in a consistent format regardless of the payer.

At Availity, you can:

Request authorizations.
Submit claims.
Confirm eligibility.

Provider News

The latest articles and announcements on claims filings, products, benefits, administrative updates, new and revised procedures and guidelines, prescription information, and more.

Medicaid updates

Inhaled nitric oxide reviews for diagnosis-related group admissions 

The purpose of this notification is to inform participating hospitals that the use of inhaled nitric oxide (iNO) during an inpatient stay will be reviewed for medical necessity using our Clinical Utilization Management (UM) Guideline for iNO, CG-MED-69. iNO is a covered service for eligible members when the use of iNO meets medical necessity criteria Link Title: Notification regarding inhaled nitric oxide.

New Jersey FamilyCare Electronic Visit Verification (EVV) Fact Sheet (January 6, 2021)

Electronic Visit Verification (EVV) is a requirement of a federal law called the 21st Century CURES Act. All states, including New Jersey, must have EVV systems for direct care workers who provide Medicaid-funded personal care and home health care services, including both agency and self-directed workers. Personal care services must use EVV by January 1, 2021 and home health care services must use EVV by January 1, 2023.

End-of-year message from Teresa Hursey

Thank you for your service to our members. I know this has been a difficult year for all of us. This public health emergency has tested us and we have responded in ways far too numerous to list. New Jersey has been one of the most heavily impacted states in terms of the spread of COVID-19. In response to this crisis, our partners at the Department of Human Services have demonstrated real leadership in marshalling the Medicaid program’s resources. Working together, we have devoted our efforts to ensure carefor our members continues uninterrupted. Now more than ever, our members rely on our ability to respond when the normal public health infrastructure has been disrupted. Your close partnership in these efforts has been invaluable.

Reimbursement for early elective deliveries

To improve birth outcomes for our members and further reduce early elective deliveries (EEDs), effective January 1, 2021, Amerigroup Community Care will require a Z3A diagnosis code indicating the gestational age on all professional delivery claims with supporting medical necessity diagnosis codes for EEDs.

Perinatal Risk Assessment Plus form requirement

Understand which forms are required effective January 1, 2021.

New doula care benefit

Effective January 1, 2021, Amerigroup Community Care provides pregnant members with the option to receive supportive care throughout pregnancy and during the postpartum period from a participating certified doula.

Specialty Pharmacy Prior Authorization Updates

Effective for dates of service on and after February 1, 2021, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our precertification review process.

Medicare updates

Medicare Advantage — PN for UM AROW Item 1330

On April 1, 2021, Amerigroup prior authorization (PA) requirements will change for the following codes.

Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology

New specialty pharmacy medical step therapy requirements

Effective January 1, 2021, the following Part B medications from the current Clinical Utilization Management (UM) Guidelines will be included in our medical step therapy precertification review process.

New specialty pharmacy medical step therapy requirements

Effective January 1, 2021, the following Part B medications from the current Clinical Utilization Management (UM) Guidelines will be included in our medical step therapy precertification review process.

Amerigroup Amerivantage (Medicare Advantage) expands specialty pharmacy precertification list effective January 1, 2021

Effective for dates of service on and after January 1, 2021, specialty Medicare Part B drugs listed will be included in our precertification review process.

Featured resources

Pharmacy Information

Search for up-to-date drug information, including hundreds of brand-name and generic medications.

Maternal child program

When it comes to our pregnant members, we are committed to keeping both mom and baby healthy. We encourage all our moms-to-be to take part in our Taking Care of Baby and Me® program, which is a comprehensive, proactive case management and care coordination program for all expectant mothers and their newborns.

Behavioral health provider

We work collaboratively with hospitals, group practices and independent behavioral health care providers, community and government agencies, human service districts, and other resources to successfully meet the needs of members with behavioral health, substance use, and intellectual and developmental disabilities.

NCQA Health Plan Recognition

Amerigroup has been a NCQA Commendable plan in New Jersey since 2017.

Provider tools & resources

Interested in becoming a provider in our network?

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