Amerigroup. An Anthem Company.

Texas Providers

Prior authorization requirements


To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

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Behavioral health

Submit requests through our Interactive Care Reviewer (ICR) tool via Availity.

You may also fax requests for services that require prior authorization to:


Inpatient:

1-844-430-6805

Outpatient:

1-844-442-8010

Services billed with the following revenue codes always require precertification:

0240–0249 all-inclusive ancillary psychiatric
0901, 0905–0907, 0913 and 0917 behavioral health treatment services
0944–0945 other therapeutic services
0961 psychiatric professional fees

Pharmacy

Services billed with the following revenue codes always require prior authorization:

0632 Pharmacy multiple sources

Medicare/Long-Term Services and Supports

Medicare


Prior authorization is not required for physician evaluation and management (E&M) services for members of the Medicare Advantage Classic plan.

Long-Term Services and Supports

All services require prior authorization. Please use the fax numbers below to submit your requests.

STAR Kids

Fax: 1-844-756-4604

STAR+PLUS

Austin

Fax: 1-877-744-2334

STAR+PLUS

Lubbock

Fax: 1-888-822-5761

STAR+PLUS

STAR+PLUS Nursing Facility

Fax: 1-844-206-3445

STAR+PLUS

El Paso

Fax: 1-888-822-5790

STAR+PLUS

San Antonio

Fax: 1-877-820-9014

STAR+PLUS

Houston/Beaumont

Fax: 1-888-820-6828

STAR+PLUS

Tarrant/RSA

Fax: 1-888-562-5160

The following always require prior authorization:

Elective services provided by or arranged at nonparticipating facilities.

All services billed with the following revenue codes:

0023 home health prospective payment system
0570-0572, 0579 home health aide
0944–0945 other therapeutic services
3101-3109 adult day and foster care

Related information

Provider tools & resources

Interested in becoming a provider in the Amerigroup network?

We look forward to working with you to provide quality services to our members.