Update about the EVV mandate
Effective May 1, 2021, Amerigroup Community Care will cease providing approvals of PCA services and will cease payments to provider agencies that are not fully compliant by July 1, 2021.
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.
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 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.
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.