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 manuals and Quick Reference Cards
The 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.
- Provider Digital Engagement Supplement
- Medical Policies and Clinical UM Guidelines
- Electronic Clinical Data Systems coding booklet
- HEDIS Coding Booklet 2023
- HEDIS Desktop Reference Guide 2023 TN
- Intermediate Care Facility for Individuals with Intellectual Disabilities Provider Quick Reference Guide
- 1915(c) Waiver Program Provider Quick Reference Guide
- Reportable Event Management QRG
- Intellectual/Developmental Disabilities Managed Long Term Services and Supports Programs Provider Manual Supplement
- Member Handbook - English
- Member Handbook - Spanish
- Medicare Provider Dispute, Grievance and Appeal FAQ
- Medicare provider manual
- Medicaid provider manual
- Provider Manual Supplement TennCare CHOICES
- Provider Quick Reference Guide
- Quick Guide: Provider Demographic and Termination Updates
- Sample Medicare Advantage Member ID Cards
- CHOICES Provider Quick Reference Guide
- ECF CHOICES Provider Quick Reference Guide
- Centers of Medical Excellence Transplant Operations Manual
- Community Living Supports (CLS) Provider Manual
- Amerigroup MTM Operations Manual
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.
Medical Policies and Clinical UM Guidelines
- Clinical Utilization Management Criteria February 2023
- November 2022 Clinical Utilization Management Guidelines
- Site of Care Drug List
- February 2022 Clinical Utilization Management (UM) Guidelines
- November 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- Adult Chiropractic Clinical Guideline for Tennessee
- 2019 Preventive Health Guidelines
- 2022 Clinical Practice Guidelines
- February 2021 Clinical Utilization Management (UM) Guidelines
- November 2020 Clinical Utilization Management (UM) Guidelines
- August 2020 Clinical Utilization Management (UM) Guidelines
- May 2020 Clinical Utilization Management (UM) Guidelines
- February 2020 Clinical Utilization Management (UM) Guidelines
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Precertification lookup tool
- Precertification requirements
- Claims overview
- Member eligibility & pharmacy overview
- Policies, guidelines & manuals
- Referrals
- Forms
- Training academy
- Pharmacy information
- Electronic data interchange (EDI)