Provider manuals and guides
Amerigroup is committed to supporting you in providing quality care and services to our members. Here, you will find information for assessing treatment options, guidelines for clinical Utilization Management (UM), practice policies and support for delivering benefits to our members.
Provider Manual
Amerigroup provider manuals provide key administrative information, including plan benefits, member eligibility, the Quality Improvement Program, the UM program, credentialing and quality standards for participation, claims submission and appeals, and reimbursement and administration policies.
Documents
- Medicaid/CHIP Provider Manual
- Medicaid/CHIP Provider Quick Reference Guide
- Medicare provider manual
- Medicare Provider Dispute, Grievance and Appeal FAQ
- Medicare Advantage Quick Reference Card
- STAR+PLUS MMP (Medicare-Medicaid Plan) Provider Manual
- Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan) Provider Manual – Nonemergency Medical Transportation services
- Amerigroup STAR+PLUS MMP Provider Manual — Nonemergency Ambulance Transportation services
- Nursing Facility Provider Manual
- Centers of Medical Excellence Transplant Operations Manual
Medical Policies and Clinical UM Guidelines
There are several factors that impact whether a service or procedure is covered under a member’s benefit plan. Medical policies and Clinical Utilization Management (UM) Guidelines are two resources that help us determine if a procedure is medically necessary.
Medical Policies and Clinical UM Guidelines
Documents
- Clinical Practice Guidelines Matrix
- Updated Clinical Practice and Preventive Guidelines
- Preventive Health Guidelines (English)
- Preventive Health Guidelines (Spanish)
- Medicare Advantage ID Card sample
- February 2020 Clinical Utilization Management (UM) Guidelines
- May 2020 Clinical Utilization Management (UM) Guidelines
- August 2020 Clinical Utilization Management (UM) Guidelines
- November 2020 Clinical Utilization Management (UM) Guidelines
- May 2021 Clinical Utilization Management (UM) Guidelines
- August 2021 Clinical Utilization Management (UM) Guidelines
- November 2021 Clinical Utilization Management (UM) Guidelines
- February 2022 Clinical Utilization Management (UM) Guidelines
Provider tools & resources
- Log in to Availity
- Launch Provider Learning Hub Now
- Learn about Availity
- Precertification Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Referrals
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)