Maternal child services
The Taking Care of Baby and Me® program is a comprehensive proactive case management and care coordination program for all expectant mothers and their newborns. It offers:
- Individualized, one-on-one case management support for women at the highest risk.
- Care coordination for moms who may need a little extra support.
- Educational materials and information on community resources.
- Incentives to keep up with prenatal and postpartum checkups.
This program helps identify pregnant women as early in their pregnancies as possible. Once pregnant members are identified, we act quickly to assess obstetrical risk and ensure appropriate levels of care and case management services to mitigate risk.
If you would like more information about the Obstetrical (OB) Case Management program or have a patient who would benefit from care management, call Provider Services at 1-800-454-3730.
We require notification of pregnancy after the first prenatal visit and notification of delivery following birth. You may choose to complete the notification of pregnancy and delivery in the online Interactive Care Reviewer or fax the forms to Amerigroup Community Care at 1-800-964-3627.
If you have a patient who would benefit from care management, call Provider Services
Fax the forms to Amerigroup Community Care
We also encourage providers to complete the Maternity Module in Availity:
- Perform an Eligibility and Benefits request on an Amerigroup member.
- Choose one of the following benefit service types: maternity, obstetrical, gynecological, obstetrical/gynecological.
- Before the benefit results screen, you will be asked if the member is pregnant. Choose Yes, if applicable, and note the estimated due date. You can leave this blank if the due date is unknown.
After submitting your answer, you’ll be taken to the member’s benefits page. A Maternity Module will now be available for this member in the Payer Spaces section of Availity.
Substance use disorders in pregnancy and neonatal abstinence syndrome
Substance use disorders (SUDs) are on the rise and are of particular concern in women of childbearing age who are or may become pregnant. OB providers have a unique opportunity to help break the pattern of opioid misuse, avoiding health consequences for both mother and child. The important steps in this practice are to identify treat, and/or refer to treatment women who are using unhealthy substances. Amerigroup is here to support providers, pregnant members and their little ones on the way.
If you would like more information about the OB Case Management program or have a patient who would benefit from care management, call Provider Services at 1-800-454-3730.
My Advocate® program
As part of our program, members are offered the My Advocate program. This program provides pregnant and postpartum women with proactive, culturally appropriate outreach and education through interactive voice response, smartphone application or website. Eligible members receive regular calls with tailored content from a voice personality (Mary Beth) or they may choose to access the program via a smartphone application or website. This program does not replace the high touch case management approach for high-risk pregnant women. However, it does serve as a supplementary tool to extend our health education reach.
Each automated My Advocate communication gives the member specific health care education in a warm, easy-to-understand fashion. Eligible members receive regular messages with tailored content from Mary Beth in English or Spanish. The topics include:
- Obstetric high-risk screening.
- Maternal and child health:
- Prenatal care
- Postpartum care
- Well-baby care
For more information on My Advocate, visit www.myadvocatehelps.com.
Neonatal Intensive Care Unit (NICU) Program
The NICU Care Management program is committed to ensuring that all of our high-risk infants have a well-defined plan for quality and cost effective NICU care and, when ready, a safe and successful transition to the home environment. We provide a seamless, integrated approach, including early identification of members for NICU Care Management through case closure.
Our NICU Care Management program encourages parental involvement in their infant’s care while hospitalized in the NICU. We focus on parents of infants expected to be in the hospital greater than two weeks who were born at 34 or fewer weeks gestation, born weighing 2000 grams or less, born with major congenital anomalies, require ventilator care, or require major surgery. We provide education and support designed to help them cope with the day-to-day stress of having a baby in the NICU, encourage them to stay involved in the care of their babies and help them prepare themselves and their homes for discharge.
The stress of having a critically ill infant in the NICU can potentially result in post-traumatic stress disorder (PTSD) symptoms among parents and loved ones. In an effort to reduce the impact of PTSD among our members, we assist by:
- Guiding parent(s) into hospital-based support programs, if available, as well as to target support services and referrals to providers.
- Screening parent(s) for PTSD approximately one month after the date of birth.
- Referring parent(s) to behavioral health program resources, if indicated.
- Reconnecting with families with a one-month follow-up call to assess if the parent(s) received benefit from initial contact and PTSD awareness.
If you would like more information about the NICU Care Management program or have a patient who would benefit, call Provider Services
Call Provider Services:
To view and access forms related to pregnancy and maternal child services, please visit the Forms page.
- Coding Spotlight — Pregnancy: A provider’s guide to diagnosis coding for pregnancy
- Maternal Health Resources
- Postpartum Mood Disorder Flier
- Perinatal Risk Assessment Plus form requirement
- New doula care benefit
- Availity Provider Notice
- Availity FAQ
- Prenatal Ultrasound Policy/ICD-10 Update
- Cervical Cancer Screening Frequency
- Correction: Cervical length measurement by transvaginal ultrasound
- Reimbursement for early elective deliveries
- Cervical Length Screening Guidelines
- PCPs should assist members to establish a dental home
- Prematurity Prevention Initiative Flyer
- Taking Care of Baby and Me Provider Booklet
- Pregnancy notification process using the Benefit Look-Up Tool
- Postpartum Interventions for Maternal Morbidity and Mortality
- Maternal Cardiovascular Health Flier
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
- Provider manual and guides
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)