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Amerigroup kansas provider manual1 Provider Manual Kansas n providers.amerigroup.com/ks 2 February 2015 Request to participate in the network Interest in participating in the network Amerigroup Kansas, Inc.? Visit providers.amerigroup.com/ks or call and select Kansas. General information about this manual We reserve the right to add, delete andotherwise modify this manual. 30 days before the effective date, we will notify network providers of any changes to this guide. All rights reserved. This publication or any part therefor may not be reproduced or transmitted in any form or in any form, electronic or mechanical, including copying, recording, storage in theinformation re seeking system or otherwise, without the prior written consent of: Brand and Marketing Communications Amerigroup Corporation 4425 Corporation Lane Virginia Beach, VA Telephone: The material in this manual may change. For the most up-to-date information, providers.amerigroup.com/ks. The rest ofthis page is deliberately left blank. 3 Content INTRODUCTION WHO WE QUICK REFERENCE CONTACT INFORMATION Our website Important contact information Receivables Provider Claims Claims Filing and meeting procedures KANCARE FRONT-END BILLINGHOUSE FILING WEB-BASED CLAIMS FILINGPAPER CLAIMS FILING Meet claims data Adjudication Timely filing net claims payment claims claims Status coordination benefits and third-party party liability reimbursement policy reimbursement policy reimbursement reviews hierarchy review and update reimbursement by code definition Overpayment Process RefundReview of Members ADVANCED RECIPIENT NOTICE PROVIDER COMPLAINTS AND PAYMENT APPEAL PROCEDURES PROVIDER COMPLAINTS PROCEDURES VERBAL COMPLAINTS PROCESS CLAIMS PAYMENT QUERIES OR withdrawal of payment withdrawal program program overview, BENEFITSAND LIMITATIONS OF KANCARE PROGRAMS DESCRIPTION COVERED BY BENEFITS THROUGH AMERIGROUP PROJECTED ELIGIBILITY AMERIGROUP VALUE-ADDED SERVICES BLOOD LEAD SCREENINGS FINANCIAL MANAGEMENT SERVICES IMMUNIZATION MEDICALLY NECESSARYPHARMACY CARE SERVICES CHILDCARE CARE AND I PREGNANCY SUPPORT PROGRAM PRECERTIFICATION AND NOTIFICATION PROCESSES 4 CONFIDENTIALITY INFORMATION DURING THE PRECERTIFICATION PROCESS AND INSTRUCTIONS FOR NOTIFICATION OF DISCHARGE PLANNINGEMERGENCY ROOM EMERGENCY ROOM PRUDENT LAYPERSON REVIEWS HOSPITALIZATION HOSPITALIZATION HOSPITALIZATION REVIEWS OF NON-AMERICAN OUTPATIENT AND COMPLEMENTARY EMERGENCY CARE SERVICES/AFTER-HOURS CARE PROVIDER TYPES, ACCESS ANDAVAILABILITY OF PRIMARY CARE PROVIDER RESPONSIBILITIES WHO MAY BE PRIMARY CARE PROVIDERS? PRIMARY CARE PROVIDER ONSITE AVAILABILITY PROVIDER PRIMARY CARE ACCESS AND AVAILABILITY PROVIDERS SPECIAL CARE ACCESS TO WOMEN HEALTH SPECIALISTS ROLEAND RESPONSIBILITY PROVIDERS SPECIAL CARE PROVIDERS SPECIAL CARE ACCESS AND AVAILABILITY INDIAN HEALTH SERVICES, URBAN INDIAN HEALTH CLINICS TRIBAL HEALTH CENTERS WE ACCEPT CURRENT LICENSE PRACTICE IN THE UNITED STATES OR THEIR TERRITORY FROMEACH INDIVIDUAL PROVIDER EMPLOYED BY IHS, THE CITY'S INDIAN HEALTH CLINIC OR TRIBAL FACILITY 638 AND CONSIDER ACCEPTING THIS LICENSE IN ORDER TO MEET THE LICENSE REQUIREMENTS FOR OUR PARTICIPATION IN THE NETWORK. EACH PROVIDER OF BARRELPROCESSING SERVICES IN AN ESTABLISHMENT MUST ALSO BE LICENSED BY THE STATE TO PROVIDE PROCEDURES TO OUT-OF-NETWORK SERVICE PROVIDERS, TOOLS AND SUPPORT BEHAVIORAL HEALTH CONSULTATION BEHAVIORAL HEALTH SCREENING TOOLS CHANGES INADDRESS AND/OR PRACTICE STATE OF CLINICAL PRACTICE GUIDELINES REGARDING PHYSICIAN CULTURAL COMPETENCY SCAMS, WASTE AND ABUSE HEALTH INSURANCE PORTABILITY AND LIABILITY ACT LAB REQUIREMENTS CLINICAL LABORATORY IMPROVEMENTS CHANGESCHANGES MARKETING PROHIBITED SERVICES PROVIDER ACTIVITIES HEALTH EVALUATION PERMITTED PENALTIES RECORDS MEMBER MEDICAL RECORDS DOCUMENTATION Standards for episode care records standards patient visit date recommendations ii 5 7.16 rights and obligations of ourmembers law members rights our providers satisfaction surveys state fair hearing process for provider support and training for provider support and communication tools training additional medical education loans tools to help you manage our Members Eligibility (PANEL) LISTINGS Identification card members withspecial needs member grievances member appeal benefits member missed appointment member unfulfilled second administrative opinion LOCK-IN PROGRAM, HOW DO WE SUPPORT OUR AMERIGROUP MEMBERS AS A HOME HEALTH MEMBER AMERIGROUP ON THE CALL FOR AUTOMATICASSIGNMENT OF PRIMARY CARE PROVIDERS ADVANCE DIRECTIVE CASE MANAGEMENT SERVICES MANAGEMENT CENTRALIZED CARE UNIT ENROLLMENT INTERPRETER SERVICE DIRECTORIES WELCOME CALL WELL-CHILD VISITS REMINDER PROGRAM QUALITY MANAGEMENTPROGRAM USE QUALITY CARE QUALITY CARE COMMITTEE FOR MANAGEMENT MEDICAL REVIEW CRITERIA CLINICAL CRITERIA MEDICAL ADVISORY COMMITTEE CREDENTIAL CREDENTIAL CREDENTIAL CREDENTIAL PROCEDURES RECREDENTIALING III 6 6 10.12 RIGHTS PROVIDERSDURING CREDENTIAL/ RECREDENTIALING PROCESSES ORGANIZATIONAL PROVIDERS DELEGATED CREDENTIALS PEER REVIEW SUPPLEMENT AND FORMS APPENDIX B Behavioral Health Integrated Services Overview of Behavioral Health at AMERIGROUP KANSAS Recovery and Resilience MemberRecords and Treatment Planning Clinical Practice Guidelines Coordination behavioral health and physical health care Training Supplement C procedures for qualified nursing/nursing homes Supplement D procedures for waiver providers services and other long-term services and supports member eligibility forexceptions E procedures for financial management of service providers the rest of this site is intentionally left blank. iv 7 Welcome to our network. We are glad that you are in our network of quality providers. We recognise that hospitals, doctors and other providers play a key role in Gaining your respect and gainingloyalty are essential for successful cooperation in providing quality healthcare. This provider's guide contains everything you need to know about us, our programs, and how we work with you. This information may change. We recommend that you use the manual that is available on the providers.amerigroup.com/ks upto-date information. We want to hear it from you! Participate in one of our quality improvement committees or call our service provider team for suggestions, comments or questions. Together, we can change the lives of our KanCare members. 8 1. INTRODUCTION 1.1 Who We Are Amerigroup Kansas, Inc. (Amerigroup)is a wholly owned subsidiary of Anthem, Inc. (Anthem). As a leader in managed health services for the public sector, anthem-run health plans help low-income families, children, pregnant women, people with disabilities; elderly people will receive the healthcare they need. We help coordinate physical and behavioralhealth care, as well as nursing facilities and home and community services (HCBS). We offer education, access to care and disease management programs. As a result, we reduce costs, improve quality and promote better health for our members. We: Improve access to preventive health care services Ensure that ourmembers select primary care providers who serve as providers, care managers and coordinators for all essential medical services to help improve health outcomes for members educate our members about their benefits, responsibilities and appropriate use of care Use community businesses and community reach tohelp our members integrate physical and behavioral healthcare to address the whole person Support: Stable relationships between our providers and members Appropriate use of specialists, urgent care centers and emergency departments In a world of escalating healthcare costs, we are working to educate ourmembers about the appropriate use of our managed care system and their involvement in all aspects of their healthcare. 1.2 Brief Contact Contact Information Our website Our website provider, providers.amerigroup.com/ks, offers a full range of tools including: Advanced account management tools for timely updates ofyour contact information in our systems download form Detailed search eligibility tool Comprehensive, downloadable lists of member panels and population-centric reporting Easier authorization requirements to locate and submit Access drug coverage information Special training for you and your office staff List of openissues related to entitlements and their status For technical support when using our provider website, call our team of providers. Technical support personnel are available from 07:00 to 19:00 Central Time. KS-PM 9 Important Contact Information Our Kansas Office Address Amerigroup Kansas, Inc. Indian Creek Building32 Overland Park, KS Phone: Fax: Amerigroup Service Provider Phone: Live Agents Agents Monday through Friday from 8:00 a.m. to 5:00 p.m. Central Time Fax: Interactive Voice Response (IVR) System available: 24 hours a day, 7 days a week Kansas Provider Services Direct Line: Use this number for all nonclaimrelated concerns. Use the link directory on our provider's self-service website to find other Amerigroup network providers and substance use disorder services. For information about how to help you reference service members and providers near them, contact your provider's service team. Amerigroup Behavioral HealthServices Providers call: Members call: Fax numbers: General faxes: Outpatient faxes: Amerigroup Member Services Live agents are available Monday through Friday from 8:00 a.m. to 5:00 p.m. Central Time Self Service Voice Portal available 24/7 Interpreter services for members are available Amerigroup On Call /(Spanish ) Sister HelpLine for Members Live Agents available 24/7 KS-PM 10 Amerigroup Electronic Data Exchange Hotline AT & T Relay Services (Spanish) Case Managers Call Amerigroup Provider Services. Case managers available from 8:00 a.m. 5:00 p.m. Central time. Claims Information File claimsonline at providers.amerigroup.com/ks. Check the status of complaints online or through our IVR system. Electronic Claims Payer ID: Emdeon (formerly WebMD) is Capario's (formerly MedAvant) Availability (formerly THIN)'s Claims may also be submitted directly to KMAP through front-end billing mail paper claims to:Amerigroup Kansas, Inc. PO Box Virginia Beach, VA Dental Services through call providers Scion Dental Members calling the Kansas Department of Health & Environment Phone: (KDHE) KDHE: KanCare: Lab and Diagnostic Services LabCorp: Quest Diagnostics: Member Eligibility Verification Online atproviders.amerigroup.com/ks Member Complaints Call or Submit by Mail to: Complaint Processing Amerigroup Kansas, Inc. P.O. Box KS-PM 11 Virginia Beach, VA Member Appeals Appeal must be filed within 30 calendar days of receiving notification of the action. You may appeal on behalf of a member with the writtenconsent of that member. Members may appeal to: Amerigroup Kansas, Inc. Indian Creek Parkway, Building 32 Overland Park, KS MultiPlan, Inc. contractual providers to inquire about the status of your contract with MultiPlan Calling For any other issues, issues or service requests, call the Amerigroup Provider Serviceshelpline for assistance. Nonemergent Transportation Service Providers Call Providers: From Access2Care Members Call: Precertification/24/7 Notice Online to providers.amerigroup.com/ks By Fax by Phone Please Provide Member or Medicaid ID Member Social Security Number If Available Member with Date of BirthLegible Name referring Provider Legible Name of Person Indicated by Provider Number of Visits/Services Date(s) Service Diagnosis CPT/HCPCS Clinical Information Provider Complaints: Submit verbal complaints to: Service Provider at Amerigroup Kansas Health Plan Your Local Relationships Representative KS-PMFile a complaint in writing by letter or fax to: Amerigroup Kansas, Inc. Indian Creek Parkway, Building 32 Overland Park, KS Fax 12 You may also appear in person at the above address to submit a complaint Pharmacy Precertification by Phone: Fax: Or to KS-PM 13 Vision Services through providers calling eye benefitmembers calling Provider Claims Payments Questions or Problems Our Provider Experience Program will help you with claims payments and issuance solutions. Just call and select the Claim prompt when you hear it. We will connect you with a dedicated resource team called The Provider Services Department (PSU) toensure: Availability of useful and knowledgeable representatives to help you increase first contact, troubleshooting rate Significantly improved response time of increased informational communication solution to inform you about your status query Claims Payments Recall If after talking to the PSU your claim issueremains unresolved , you can submit a formal payment request. Oral and written appeals are accepted. The Appeal against Payment for Claim section of this guide provides specific guidelines that explain situations where a verbal appeal is not accepted. The PSU agent will assist you in determining this. Regardless ofwhether we have submitted an application orally or in writing, we must receive an appeal for payment within 90 calendar days from the date of the EOP. We will send you the decision within 30 calendar days of receiving the appeal. If you are not satisfied, you can submit an application for a second level review. Verbalappeals for second-level reviews are not accepted. We must receive your written request within 30 calendar days of receipt of the first degree. Submit a written payment appeal to: Payment Appeals Unit of Amerigroup Kansas, Inc. P.O. Box Virginia Beach, VA If you have exhausted the Amerigroup payment appealsprocess and are still not satisfied with our resolution, you have the right to a state fair hearing with the Office of Administrative Hearings (OAH). For more details, see the State Fair Hearing section of this guide. KS-PM 14 2. CLAIMS FILING AND MEETING PROCEDURES You have the opportunity to file a claimelectronically or by post. We recommend using electronic claims methods to help you: Get payment explanations and your refunds faster Eliminate paper waste Save time 2.1 KanCare Front-end Billing For your convenience, you can continue to send kansas medicaid claims to the state electronically. The KansasDepartment of Health and Environment (KDHE) will submit your application information to each managed care organization (MCO) through 837 daily batch files. As of February 1, 2015, the fiscal agent will no longer accept paper entitlements. These must be submitted directly to Amerigroup. 2.2 ClearinghouseSubmissions You may make electronic claims through electronic data exchange (EDI). Claims can be made through: Emdeon (formerly WebMD) Claim Payer Capario (formerly MedAvant) Claim Payer ID Availability (formerly THIN) Claim for identity payer State of Kansas EDI claims filing guide is located onproviders.amerigroup.com/ks. 2.3 Web Claim Submitting claims on our website: By entering claims for pre-formatted cms-1500 and CMS-1450/UB04 complaint template Upload a HIPAA-compatible ANSI ad To start the process of electronic filing of complaints or if you have questions, please contact our EDI Hotline forpaper claim submissions All paper claims to be submitted directly to Amerigroup: Amerigroup Kansas, Inc. P.O. Box Virginia Beach, VA CMS-1500 and CMS-1450/UB04 forms are available on our provider's website at providers.amerigroup.com/ks. 2.5 Meeting data You must submit meeting data within the earlysubmission deadlines set out in the Claims Adjudication section of this guide via: EDI CMS-1500 (08-05) or 1450/UB-04 Application Form Further Action, which are approved by Amerigroup KS-PM 15 Encounter data are the following required information data: Member's name (first and last name) Member ID Member'sdate of birth Name of the provider under the contract Amerigroup provider number Coordination of information about benefits Date of meeting Types of services Provided Diagnostics (possibly using current codes and modifiers) Number ID of provider NPI/API number Our usage and quality improvement staff monitorcompliance, coordinate it with the medical director and quarterly report to QMC. Non-compliance will result in: Follow-up training audits I termination 2.6 Claims Decision making We are committed to providing timely decision making on claims. We process all claims in accordance with generally accepted coding andpayment guidelines defined in CPT-4 and ICD-9. When posting amerigroup automatically or on paper, hipaa-compatible billing codes must be used. When updating billing codes, you must use the appropriate replacement codes for the submitted claims. We reject claims sent with incompatible billing codes. We reservethe right to use code editing software to determine which services are considered part of the primary procedure, are considered part of the primary procedure, and are included in this process. Timely paper submission and electronic claims must be submitted within: 90 calendar days for participating providers. 180calendar days for non-participating providers. The time limits for submission shall begin on the date of discharge for inpatient services and from the date of delivery of outpatient/medical services. Timely submission requirements are defined in the contract with the provider; Detailed requirements can be found in it. Thereare exceptions to the requirements of timely administration. These include: cases of dose coordination/subrogation. In the case of coordination of benefits/subrogation, the time limits for bringing an action shall begin on the date of resolution of the claim by a third party. Cases where a member has a retroactive InAmerigroup enrollment situations retroactively with the eligibility date, the application period will begin on the day when Amerigroup receives notification from the enrollment broker of the eligibility of the member/enrollment. We will deny claims filed after the deadline for filing. KS-PM 16 Timely confirmation documentationThe following information will be considered as proof that the claim was received in a timely manner. If the claim is made: by post in the USA: first class, requested confirmation of return or delivery overnight; the provider must provide a copy of the claim log that identifies each claim contained in the submissionelectronically: the provider must provide the clearinghouse assigned the date of receipt from the manual delivery reconciliation reports: the provider must provide the claim log, which identifies each claim contained in the delivery and a copy of the signed hand delivery receipt The claim report maintained by the providermust contain the following information: Plaintiff's name Address plaintiff's telephone number Plaintiff's telephone number with federal tax identification number Name of the addressee Carrier Designated address Date of dispatch or handover Participant name Participant name Name of patient Patient Name Date/s)service/event Total fee Method of delivery Good reason If the claim or complaint dispute contains explanation of delay or other evidence, which proves the reason , amerigroup shall determine a good cause on the basis of this statement or evidence and/or where the evidence leads to doubts as to the validity of thedeclaration. Amerigroup will contact the provider for explanations or other information necessary to determine a good cause. A good reason can be found if the request of the doctor or supplier was caused by a delay in administration: Administrative error: incorrect or incomplete information provided by official sources(e.g. carrier, intermediary, CMS) doctors or suppliers Incorrect information provided by a member of the doctor or supplier that led to incorrect submission to another care organisation plan or with the State Unavoidable delay in securing the required supporting documentation or evidence from one or more third partiesdespite reasonable efforts by the doctor/supplier to provide such documentation or evidence Unusual, unavoidable or other circumstances beyond the control of the service provider showing that the doctor or supplier could not reasonably have expected that he was aware of the need to file timely destruction or otherdamage to the records of the doctor or supplier , if such destruction or other damage was caused by the doctor or supplier of wilful negligence 2.7 Net claims Net claims Net claim is a claim that can be processed without obtaining additional information from the service provider or from a third party. Includes a claim witherrors originating from the state claims system. It does not include the right to a provider who is being investigated for fraud or abuse or a claim that is subject to review out of medical need. KS-PM 17 Once it has been established that the claim is not non-fracking, it must be resent in order to be considered as a net claim.We will comply with and decide on net claims for paid or denied status within: 100 percent of all net receivables, including adjustments processed and paid or processed and rejected within 30 days of receipt of 99 percent of all uncleaned receivables, including adjustments processed and paid or processed and rejectedwithin 60 days of receipt of 100 percent of all claims, including adjustments to processed and paid or processed and rejected within 90 days of receipt of nursing facilities (NF) We will comply with and decide on net claims to the paid or prohibited status as follows: Pay 90 percent of net receivables within 14 days Pay 99.5percent of net receivables within 21 days We produce and send EOP five times a week. Displays the status of each claim that was made during the previous claim cycle. If we do not receive all the required information to process your claim as net, you will see a request for missing information in your EOP. Once we havereceived the required information, we will process the complaint within the above deadlines. We will return electronic complaints that are intended to be unclean to the information centre that submitted the request. 2.8 Status of complaints Complaint status You can check the status of claims on the website of our selfservice provider or by calling our service team of the provider. You can also use claim status information for received and rejected claims that have been submitted through a clearing house. If we do not have a claim in the file, resute your claim as part of the timely filing requirements. If you are filing electronically, checkthe confirmation reports to receive the claim you receive from your EDI supplier or practice management company. 2.9 Coordinating the benefits and responsibilities of third parties When coordinating benefits, third-party liability (TPL) and medical subrogation, we adhere to Kansas-specific guidelines and all federalregulations. We use covered medical and hospital services whenever available or other public or private sources of payment for services provided to our members. The TPL applies to any individual, entity or programme that may be responsible for all or part of a member's health insurance. The State shall take allreasonable measures to identify legally responsible third parties and to consider the verified TPL as the source of each member of the plan. Amerigroup Kansas assumes responsibility for identifying and tracking TPL for our members. We will do our utmost to identify and coordinate with all third parties against whommembers may have claims for payments or payment for services. These third parties may include Medicare or any other insurance group, trade unions, social welfare, employer organisations or employee benefit organisations, including preferred provider organisations or similar type organisations, any coverage coverageprogrammes and all coverage that must be provided for by state law. KS-PM 18 If TPL resources are available to cover the cost of trauma claims and medical services provided to Medicaid members, we will reject the claim and redirect you to the appropriate insurance carrier's account (unless certain circumstances ofwage and persecution are applicable, see below). Or, if we don't know about the resource until payment for the service is provided, we will seek to recover the expenses after payment. You may not seek enforcement beyond the amount of Medicaid due. Wage and pursuit circumstances are: When there are services forpreventive pediatric care, including KAN Be Healthy (EPSDT) If there is a right to prenatal care Our dealer of subrogation processes the filing of liens and settlement negotiations both internally and externally. If you have any questions about paid, rejected or rejected claims, please call the provider's services as provider *TPL information collection Since you have direct contact with our members, you are the best source of timely third party liability information (TPL). The contribution you can make in the TPL area is very significant. You have an obligation to investigate and report the existence of other insurance or liability. Cooperation isessential for the functioning of KMAP and for ensuring rapid payment. When you receive billing information from the recipient, you should also determine whether there are additional insurance resources. Where they exist, these resources must be indicated on the application form so that claims can make properdecisions. Remember that if there is a specific insurance cover for a member, proof of termination, refusal or exhaustion of benefits must be submitted from that carrier before the file can be corrected. *Billing TPL Per 42 CFR (b), if the probable existence of TPL (such as Medicare or health insurance) is established at thetime of application, Amerigroup must reject the claim and return it to the provider to determine the amount of liability. This means that the provider must try to charge for other insurance before making a claim to Amerigroup The provider must comply with the rules of the primary insurance plan (such as obtaining priorauthorization) or the related Amerigroup claim will be rejected. It is important that providers keep adequate records of third party efforts for at least five years. These records, like all other records, are audited by health and social services, the Centers for Medicare and Medicaid Services (CMS), the state's Medicaidagency, or one of their representatives. Kansas requires the recipient to comply with the rules of any insurance plan that is primary for KanCare. If a member does not cooperate and does not comply with the rules of the insurance plan (such as staying on the network, obtaining a referral, obtaining proper priorauthorisation), the related Amerigroup claim will be rejected. CMS does not have allow federal dollars to be spent if a member does not cooperate with access to other insurance or follow the applicable rules of their other insurance plan. You may not charge Amerigroup the depreciation amount of another insuranceprovider (sometimes referred to as the contractual depreciation amount). Amerigroup should only be charged for the remaining amount of patient liability, if any. KS-PM 19 If the service is not covered by the recipient's primary insurance plan, a flat-rate rejection letter may be requested from the carrier. From the insurancecarrier, the provider must ask for a letter, on the letterhead of the company, stating that the service is not covered by the insurance plan covering the member. You may not charge our members or any financially responsible relative or representative of the Member any amount in excess of the amount paid byAmerigroup. Section 1902 (a) (25)(C) of the Social Security Act prohibits Medicaid providers from directly billing Medicaid recipients. § 1902 g) allows a reduction of payments otherwise due to the provider in the amount of up to three times the amount of any payment to be collected, that person in violation of subsection(a)(25)(c). *Long-term care insurance If there is long-term care insurance (LTC), it must be considered tpl and costs must be avoided. If you find insurance that should be paid for by primary Medicaid after receiving payment from Medicaid, you must charge that insurance carrier and try to withdraw the payment.Amerigroup cannot be revoked if the claim has been transferred from Medicare to Medicaid, resulting in a zero-paid claim because the zero claim paid cannot be adjusted. When you authorte a Medicare entitlement to switch to Amerigroup you agree to accept the Medicaid payment as payment in full. In many cases, theclaim will result in a zero payment to Amerigroup because the Medicare payment is greater than the Amerigroup amount allowed. If you want to track potential third parties after Medicare, but before filing Medicaid claims, inform Amerigroup that you don't want any Medicare claims to pass. You can balance an Amerigroupaccount, but are not required if Medicare and other third-party payments received exceed the Amerigroup allowed amount. Medicare-related entitlements If a patient is eligible for Medicare payment, providers must first submit an application to Medicare (unless they are Medicare-exempt services). If a patient is 65 yearsof age or over, has chronic kidney disease, or is blind or disabled, efforts should be made to determine medicare eligibility. You may not seek to collect from an Amerigroup member or any financially responsible relative or representative of a member the difference between medicare/medicaid permitted and fees chargedby you (S.S.A. 1902(a)(25)(C). You should charge Medicare-noncovered and Medicare-covered services separately to ensure proper reimbursement. Medicare-covered services should be charged medicare and automatically switched. Medicare should not be charged medicare, but instead directly to Amerigroup or otherprimary payers. If it is not possible to clearly determine whether the resources are related to Medicare (including Medicare replacement plans or Part C Advantage plans) or other health insurance, the claim will not be processed, but will be returned with an explanation request. Entitlements automa
Use the link directory on our provider's self-service website to find other Amerigroup network providers and substance use disorder services. For information about how to help you reference service members and providers near the
