Quarterly pharmacy formulary change notice effective August 1, 2021
Formulary changes reviewed and approved at our 1st quarter 2021, pharmacy and therapeutics committee meeting.
Voluntary recall of Philips Respironics CPAP machine, BiPAP machine, and ventilators
On June 14, 2021, Philips Respironics* issued a voluntary recall on specific brands of their continuous positive airway pressure (CPAP) machines, bilevel positive airway pressure (BiPAP) machines, and ventilators.
Personal care group services authorization and claim coding
Effective July 1, 2021, providers requesting authorization or billing for personal care assistance group services must use code T1019-HQ. Any existing authorizations using code S5125 will be end-dated for June 30, 2021. Existing authorizations that extend beyond June 30, 2021, will be transitioned to code T1019-HQ and revised authorizations reflecting this change will be provided by fax.
Infusion Step Therapy Retraction Notice and Update about the EVV Mandate Removed
Providers are cordially invited to attend a live training webinar cohosted by CareBridge* and Amerigroup Community Care on June 4, 2021.
Aspire Health for NJ FamilyCare Members in Need of Palliative Care
Amerigroup Community Care works with Aspire Health to provide in-home and virtual palliative care services to our members facing advanced illness.
Medicare Advantage — PN for UM AROW Item 1577
On September 1, 2021, Amerigroup prior authorization (PA) requirements will change for the following codes.
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.