Provider manuals and guides
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 Guides
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.
Documents
- 2022 Clinical Practice Guideline Update
- Medicaid Provider Manual
- Medicare provider manual
- Quick Reference Guide
- Rights and responsibilities of members enrolled in Amerigroup Community Care
- FQHC Billing Guide
- Centers of Medical Excellence Transplant Operations Manual
- Provider Manual and Quick Reference Guide
Medical Policies and Clinical UM Guidelines
Medical policy addresses 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.
Documents
- Updated Clinical Practice Guidelines now available online
- Cognitive Care Program
- Clinical Practice Guidelines Matrix
- 2020 Preventive Health Guidelines
- Medicare Advantage Products
- Sample Medicare Advantage Member ID Cards
- 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
- November 2021 Clinical Utilization Management (UM) Guidelines
- February 2022 Clinical Utilization Management (UM) Guidelines
- Developmental Individual-difference Relationship-based (DIR) UM Guideline
- August 2022 Clinical Utilization Management Guidelines
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
- Referrals
- Forms
- Training Academy
- Pharmacy information
- Electronic Data Interchange (EDI)