Provider NewsletterAmerigroup Washington, Inc.https://providers.amerigroup.com/��Medicaid providers: 1-800-454-3730 Medicare providers: 1-866-805-4589

August 2019WA-NL-0323-19

August 2019

Table of ContentsMedicaid:Prepayment clinical validation review process Page 2

Unspecified diagnosis code update Page 2

AIM Specialty Health® programs may require documentation Page 2

Provider payment schedule updates Page 3

Coming soon: electronic attachments Page 3

HEDIS® Spotlight Page 4

New service types added to Availity Page 6

Pharmacy management information Page 6

Pharmacy updates to the provider website Page 6

Update your information Page 7

Hearing aid coverage Page 7

Our Family Planning Text Message Campaign has launched Page 7

Care coordination expanding with preferred community health partners Page 8

Women, Infants, and Children program awareness Page 8

Claims reimbursement inquiries after June 1, 2019 Page 8

Clinical opioid policy reminder Page 9

Medicare/Medicaid Dual Eligibles — Involuntary Treatment Act Services Page 9

Medical Policies and Clinical Utilization Management Guidelines update Page 10

Prior authorization requirements Page 11

Medicare Advantage:Medicaid articles also applicable to Medicare Advantage Page 12

Special needs plans — provider training required Page 12

Reimbursement Policies:Drug Screen Testing Page 13

Emergency Department: Level of Evaluation and Management Services Page 13

Page 2 of 13

Medicaid

Prepayment clinical validation review process

Effective with dates of service on or after September 5, 2019, Amerigroup Washington, Inc. will update our audit process for claims with modifiers used to bypass claim edits. Modifier reviews will be conducted through a prepayment clinical validation review process. Claims with modifiers such as -25, -59, -57, LT/RT and other anatomical modifiers will be part of this review process.

In accordance with published reimbursement policies that document proper usage and submission of modifiers, the clinical validation review process will evaluate the proper use of these modifiers in conjunction with the edits they are bypassing (such as NCCI). Clinical analysts who are registered nurses and certified coders will review claims pended for validation, along with any related services, to determine whether it is appropriate for the modifier to bypass the edit.

If you believe a claim denial should be reviewed, please follow the applicable provider appeal process (outlined with the denial notification) and include medical records that support the usage of the modifier applied when submitting your appeal.WA-NL-0287-18

Unspecified diagnosis code update

Amerigroup Washington, Inc. previously communicated that as of July 1, 2018, we now require unspecified diagnosis codes to be used only when an established diagnosis code does not exist to describe the diagnosis for our members. Our goal is to align with ICD-10-CM requirements, using more specific diagnosis codes when available and appropriate. This includes codes that ICD-10-CM provides with laterality specifying whether the condition occurs on the left, right or is bilateral. The target effective date has been delayed for implementing the corresponding code edit. However, providers are encouraged to ensure their billing staff is aware of the required specificity in reporting ICD-10-CM diagnosis codes to prevent future denials.

Amerigroup will be sending out a follow-up article to inform providers of when to expect this requirement to go-live and any additional details for the changes made.WA-NL-0289-19

AIM Specialty Health programs may require documentation

Currently, providers submit various pre-service requests to AIM Specialty Health® (AIM). As part of our ongoing quality improvement efforts, for outpatient diagnostic imaging services, cardiac procedures and sleep studies. AIM may request documentation to support the clinical appropriateness of certain requests.

When requested, providers should verify information by submitting documentation from the medical record and/or participating in a pre-service consultation with an AIM physician reviewer. If medical necessity is not supported, the request may be denied as not medically necessary.WA-NL-0297-19

Page 3 of 13

Coming soon: electronic attachments

As we prepare for the potential regulatory-proposed standards for electronic attachments, Amerigroup Washington, Inc. will be implementing X12 275 electronic attachment transactions (version 5010) for claims.

Standard electronic attachments will bring value to you by eliminating the need for mailing paper records and reducing processing time overall.

Amerigroup and Availity will pilot electronic data interchange batch electronic attachments with previously selected providers. Both solicited and unsolicited attachments will be included in our pilots.

Attachment types

Solicited attachments: The provider sends a claim, and the payer determines there is not enough information to process the claim. The payer will then send the provider a request for additional information (currently done via letter). The provider can then send the solicited attachment transaction, with the documentation requested, to process the claim.

Unsolicited attachment: When the provider knows that the payer requires additional information to process the claim, the provider will then send the X12 837 claim with the Paper Work Included segment tracking number. Then, the provider will send the X12 275 attachment transaction with the additional information and include the tracking number that was sent on the claim for matching.

What you can do As we prepare for this change, you can help now by having conversations with your clearinghouse and/or electronic health care records vendor to determine their ability to set up the X12 275 attachment transaction capabilities.

In addition, you should be on the lookout for additional information and details about working with Amerigroup and Availity to send attachments via electronic batch.WA-NL-0300-19

Provider payment schedule updates

Currently, claim payments and remittance advice issued to providers occurs three times per week. Effective August 15, 2019, Amerigroup Washington, Inc. will transition to two days per week. This change will improve efficiency and ensure consistency between professional and facility claim payment processing. Amerigroup will continue to comply with applicable state prompt-pay requirements.WA-NL-0301-19

Page 4 of 13

Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)

HEDIS definition:

Percentage of members 3-6 years of age who had one or more well-child visits with a PCP during the measurement year

The visit must include all of the following elements:1. Health history (e.g., history of illness, family history, medications, allergies, immunizations)2. Physical development (e.g., age-appropriate milestones, jumping, riding a bike, stacking blocks, etc.)3. Mental development (e.g., age-appropriate milestones, ability to speak understandably, knowledge of

colors and numbers, behavior in kindergarten)4. Physical exam (e.g., at least two body systems assessed, tooth eruption, evidence of neglect/abuse)5. Health education/anticipatory guidance (e.g., Bright Futures handouts, exercise, nutrition, safety)

Documentation tips:Do Don’t

Physical and mental development

� Development appropriate for age � Growth and development normal for

age � Checklist of developmental milestones

for age

� Well-developed � Growing normally � Appropriately responsive for

age

Health education/ anticipatory guidance

� Educate on developmental expectations and care based on age

� Include items based on acute condition or medications

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)

HEDIS definition:

Percentage of members 3-17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement year:1. BMI percentile documentation with height and weight2. Counseling for nutrition3. Counseling for physical activity

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

HEDIS® Spotlight — W34, WCC and CIS

Page 5 of 13

Documentation tips:Do Don’t

BMI � BMI as a percentile or on age/growth graph � BMI value

Nutrition counseling

� Current diet discussion � Instruct on nutrition needs � Weight or obesity counseling

� Temporary diet for acute condition

Physical activity counseling

� Current activity discussion � Instruct on activity needs � Weight or obesity counseling

� Nonspecific (e.g., attends day care)

� Occasional walks

Childhood Immunization Status (CIS)

HEDIS definition:

Percentage of children 2 years of age who had the following immunizations:

� 4 — Diphtheria, tetanus, acellular pertussis (DTaP) � 4 — Pneumococcal conjugate (PCV) � 3 — Haemophilus influenza type B (HiB) � 3 — Hepatitis B (HepB) � 3 — Polio (IPV)

� 2 or 3 — Rotavirus (RV) � 2 — Influenza (flu) � 1 — Measles, mumps, rubella (MMR) � 1 — Chicken pox (VZV) � 1 — Hepatitis A (HepA)

Documentation tips:

� All immunizations must be completed on or before the 2nd birthday. � Parental refusal is considered noncompliant. � Rotavirus considerations include: 2 Rotarix (RV1) or 3 RotaTeq (RV5) or 1 Rotarix + 2 RotaTeq. � MMR, VZV and HepA must be administered on or between the member’s 1st and 2nd birthday. � The most common omission is two influenza vaccines on or before the 2nd birthday.

WA-NL-0311-19

HEDIS Spotlight (cont.)

Page 6 of 13

New service types added to Availity

Enhancements have been made to the Availity Portal that will now allow you to access more service types when using the Eligibility and Benefits Inquiry tool and will also allow us to share even more valuable information with you electronically.

You may have already noticed new additions to service types, including:

� Medically related transportation. � Long-term care. � Acupuncture. � Respite care. � Dermatology. � Sleep study therapy (found under

diagnostic medical). � Allergy testing.

Note, although there is an extensive list of available benefit types available when submitting an eligibility and benefits request, these types do vary by payer.

Here are some important points to remember when selecting service types:

� The benefit/service type field is populated with the last benefit type you selected. If you don’t see a specific benefit in the results, submit a new request and select the specific benefit type/service code.

� You have the ability to inquire about 50 patients at one time using the Add Multiple Patients feature.

WA-NL-0292-19

Pharmacy management information

Need up-to-date pharmacy information?Log in to our provider website to access our formulary, prior authorization forms, Preferred Drug List and process information.

Have questions about the formulary or need a paper copy? Call our Pharmacy department at 1-800-454-3730. Pharmacy technicians are available Monday-Friday from 8 a.m.-5 p.m. Pacific time. Our Member Services representatives serve as advocates for our members. To reach Member Services, please call 1-800-600-4441.WA-NL-0304-19

Pharmacy updates to the provider website

Amerigroup Washington, Inc. is including more comprehensive pharmacy information on our provider website to enhance your access to important pharmacy updates and listings.

A complete pharmacy section is available at https://providers.amerigroup.com/WA > Provider Resources & Documents > Pharmacy. You will find details about everything from prior authorization to medication assisted therapy. Please use this page as a resource for all things pharmacy related.

Select Find a Pharmacy in the top banner of the provider website home page for a list of network pharmacies. You can also open the list by selecting Find a Pharmacy under the Pharmacy drop-down menu of the Provider Documents & Resources section. After entering your search criteria, a list of pharmacies that correspond to your criteria will display. The same tool is available on the member website to assist members with finding a nearby pharmacy.

If you would like us to add specific information to the website, please call Provider Services at 1-800-454-3730 or email wa1provrelations@amerigroup.com.WA-NL-0308-19

Page 7 of 13

Update your information

We continually update our provider directories to ensure that your current practice information is available to our members. At least 30 days prior to making any changes to your practice — including updating your address and/or phone number, adding or deleting a physician from your practice, closing your practice to new patients, etc. — please notify by sending all changes on practice letterhead to waopsrequest@amerigroup.com. Thank you for your help and continued efforts in keeping our records up to date.WA-NL-0304-19

Hearing aid coverage

Did you know that Amerigroup Washington, Inc. covers hearing aids for adults and children? We will cover one new non-refurbished monaural hearing aid, including the fitting, follow-up care, batteries and repair, every five years. Please note that the member must have an average loss of 45 decibels or greater in the better ear. The loss must be based on a pure-tone audiometric evaluation performed by a licensed audiologist or a licensed hearing aid specialist at 1,000; 2,000; 3,000; and 4,000 Hertz with effective masking as indicated.

The hearing aid must meet the client’s specific hearing needs and carry a manufacturer’s warranty for a minimum of one year. More information is available on our provider website including details on the prior authorization requirements.

For members age 20 and under, hearing aids are covered separately through the Washington State Department of Social and Health Services (DSHS), and any claims should be sent directly to DSHS.WA-NL-0313-19

Our Family Planning Text Message Campaign has launched

In May 2019, Amerigroup Washington, Inc. launched the Family Planning Text Message Campaign to inform our members about their available family planning benefits. The campaign consists of 15 unique text messages that go out to members every two weeks on topics that include:

� Family planning. � Contraception. � STI prevention.

All members ages 18-45 were included in the campaign unless they are on the do not call list. Members do have to opt in to receive the text messages.

We are encouraging members to set up a family planning visit with their PCP and offering a $25 incentive to members for the visit. If your patients are looking for more information about family planning, we have added some valuable resources to our Health & Wellness section of the Amerigroup member website.

Note: As a provider, you can prescribe up to one year of contraception in one prescription for oral contraception, contraceptive rings or contraceptive patches.

If you have a question about this text message campaign or family planning coverage, please contact your local Network Relations consultant.WA-NL-0315-19

Page 8 of 13

Care coordination expanding with preferred community health partners

Effective August 1, 2019, Amerigroup Washington, Inc. will integrate community health workers used by preferred community health partners (PCHPs) into our current care management program to provide enhanced care transition for Apple Health members with complex needs. These members include those with the following situations:

� Hospital readmissions � A readmission risk score of more than 24 � Frequent emergency department visits � Multiple diagnoses � Identified social determinants of health � Lack of engagement with the PCP for three or more

months

The PCHP provides an extra layer of support by using community health workers as an extension of care management to help members navigate the complex health care system. Services complement members’ efforts to improve health outcomes. The PCHP makes an initial outreach to identified members to determine the appropriate level of services but does not provide any clinical services, replace Amerigroup case management, nor do they replace the care and care management provided by PCPs and specialists.

A PCHP community health worker may reach out to your practice to introduce themselves and establish a relationship with the physician. They may also discuss developing a mechanism by which to share information regarding patients who have been identified for complex care services.

The community health worker also broadens the impact of case management by focusing on action plan developments in various ways, such as helping members fill prescriptions, scheduling appointments and arranging rides to the doctor. They can even accompany members to appointments when appropriate and provide connections to meal delivery services.

For questions regarding PCHP and complex care services, please call 1-800-454-3730.WA-NL-0302-19

Women, Infants, and Children program awareness

Amerigroup Washington, Inc. is working to improve the health outcomes of women and children by promoting Women, Infants, and Children (WIC), the federally funded public health prevention program. The WIC program works to reduce low birth weight, improve immunization rates and promote breastfeeding by providing health screenings, nutrition education, nutrient-rich foods, breastfeeding support, referrals, and other health and social services. WIC is available for eligible pregnant women, new mothers, infants and children under the age of 5.

We have added comprehensive WIC information to the provider website including handouts, resources and links. You can visit https://providers.amerigroup.com/WA to download and share WIC materials with the families you serve and search to determine if they are eligible for WIC or find nearby WIC clinics.WA-NL-0307-19

Claims reimbursement inquiries after June 1, 2019

Chain and Pharmacy Services Administration Organization (PSAO) pharmacies can submitpaid claim appeals through their respective chain or PSAO headquarters, which will then submit appropriate data to Caremark. Independent pharmacies (those which are not affiliated with a PSAO for contracting purposes) can submit paid claim appeals using the Caremark Pharmacy Portal at https://rxservices.cvscaremark.com.WAPEC-1948-19

Page 9 of 13

Clinical opioid policy reminder

This is a reminder that on November 1, 2017, a new Health Care Authority (HCA) clinical policy pertaining to opioid prescriptions took effect for Medicaid members in Washington State. The policy limits opioids to a quantity of 18 dosages (tablets or capsules or 5-ml dose of liquid formulation) per prescription for children (20 years old and younger) and 42 dosages (tablets or capsules) per prescription for adults (21 and older).

The policy limits both short-acting and long-acting opioids to no more than 42 calendar days of opioid use within a rolling 90-day period. Use of any opioid for more than 42 days within a 90-day period is considered chronic use of opioids and requires prior authorization with a signed prescriber chronic opioid attestation. Please note, a new prior authorization request with a new signed prescriber chronic opioid attestation is required to be resubmitted after 12 months.

Opioids included in this policy are drugs which contain the following opioid ingredients: codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone, tapentadol and tramadol. This policy does not apply to medication-assisted therapy, such as Suboxone® and methadone.

Patients who are undergoing active cancer treatment or who are in hospice, palliative care or end-of-life care are exempt from this policy. New members within the first 120 days of membership in the health plan are exempt from the policy.

Expedited authorization codesExpedited authorization codes are available to provide immediate overrides at the pharmacy when patients or prescriptions meet certain criteria. Overrides are available at the pharmacy for:

� Patients in active cancer treatment, hospice care, palliative care or other end-of-life care.

� When prescribers indicate Exempt on the prescription for acute use of an opioid when member is not receiving chronic opioid treatment.

� Members who are chronic opioid users. The pharmacy can dispense a seven-day supply while requesting the attestation from the prescriber.

� New members within the first 120 days of membership in the health plan are exempt from the policy, and there is an expedited override code available as well.

The prior authorization form with provider opioid attestation can be found by going to https://providers.amerigroup.com/WA > Provier Resources & Documents > Pharmacy > Opioid PA with Attestation Form.

The HCA Clinical Opioid Policy can be located at https://www.hca.wa.gov/billers-providers-partners/programs-and-services/opioids.WA-NL-0299-19

From the Washington State Health Care Authority:Medicare/Medicaid Dual Eligibles — Involuntary Treatment Act Services

Federal and State rules and regulations dictate how to provide and pay for crisis services and involuntary treatment associated with Mental Health (MH) and Substance Use Disorder (SUD) for Medicare/Medicaid clients (dual eligibles) regardless of legal status. While State and local law may designate that particular individuals such as involuntary patients be treated at specific facilities, when providing crisis and ITA services to dual-eligibles, payment and authorization policies must address both Federal and State rules and regulations.

Read more online.

WA-NL-0325-19

Page 10 of 13

Medical Policies and Clinical Utilization Management Guidelines update

The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. For markets with carved-out pharmacy services, the applicable listings below are informational only.

To view a guideline, visit https://medicalpolicies.amerigroup.com/am_search.html.

Updates: � MED.00110 — Growth Factors, Silver-based Products and Autologous Tissues for Wound Treatment and

Soft Tissue Grafting was revised to add bioengineered autologous skin-derived products (e.g., SkinTE) as investigational and not medically necessary.

� MED.00126 — Fractional Exhaled Nitric Oxide and Exhaled Breath Condensate Measurements for Respiratory Disorders was revised to add Nasal Nitric Oxide as investigational and not medically necessary in the diagnosis and monitoring of asthma and other respiratory disorders.

� SURG.00037 — Treatment of Varicose Veins (Lower Extremities) was revised: � To replace “nonsurgical management” with “conservative therapy” in the medically necessary criteria � To add sclerotherapy used in conjunction with a balloon catheter (e.g., catheter-assisted vein

sclerotherapy [KAVS] procedure) as investigational and not medically necessary � TRANS.00035 — Mesenchymal Stem Cell Therapy for the Treatment of Joint and Ligament Disorders,

Autoimmune, Inflammatory and Degenerative Diseases (previous title: Mesenchymal Stem Cell Therapy For Orthopedic Indications)

� Includes the revised position statement: “Mesenchymal stem cell therapy is considered investigational and not medically necessary (INV&NMN) for the treatment of joint and ligament disorders caused by injury or degeneration as well as autoimmune, inflammatory and degenerative diseases.”

� Expands the document’s scope to address non-FDA approved uses of mesenchymal stem cell therapy � The following AIM Specialty Health® updates took effect on January 24, 2019:

� Advanced Imaging � Imaging of the Heart � Imaging of the Head and Neck

WA-NL-0298-19

Read more online.

� Arterial Ultrasound � Joint Surgery � Sleep Disorder Management Diagnostic and Treatment

Medical Policies On January 24, 2019, the Medical Policy and Technology Assessment Committee (MPTAC) approved several Medical Policies applicable to Amerigroup Washington, Inc. These guidelines take effect 30 days from posting. View the full update online for a list of the policies.

Clinical UM Guidelines On January 24, 2019, the MPTAC approved several Clinical UM Guidelines applicable to Amerigroup. These guidelines were adopted by the medical operations committee for Amerigroup members on March 28, 2019. View the full update online for a list of the guidelines.

Page 11 of 13

Prior authorization requirements

Hyperbaric oxygen and supervision of hyperbaric oxygen therapy

Effective October 1, 2019, prior authorization (PA) requirements will change for hyperbaric oxygen and supervision of hyperbaric oxygen therapy to be covered for Amerigroup Washington, Inc. members.

PA requirements will be added to the following:

� Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval (G0277)

� Physician attendance and supervision of hyperbaric oxygen therapy, per session (99183)

WA-NL-0305-19

Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

To request PA, you may use one of the following methods: � Web: https://www.availity.com � Fax: 1-800-964-3627 � Phone: 1-800-454-3730

Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers by accessing the Precertification Lookup Tool at https://www.availity.com via https://providers.amerigroup.com/WA. Contracted and noncontracted providers who are unable to access the Availity Portal can call Provider Services at 1-800-454-3730.

Durable medical equipment

Effective December 1, 2019, prior authorization (PA) requirements will change for the codes listed below. The listed codes will require PA by Amerigroup Washington, Inc. for Apple Health members.

PA requirements will be added to the following: � All lower extremity prosthesis — shank foot system with

vertical loading pylon (L5987) � Gait trainer, pediatric size — anterior support, includes all

accessories and components (E8002) � Wheelchair, pediatric size — tilt-in-space, folding, adjustable,

without seating system (E1234) � Wheelchair, pediatric size — tilt-in-space, rigid, adjustable,

without seating system (E1233) � Transport chair, pediatric size (E1037) � Multi-positional patient transfer system with integrated seat,

operated by care giver (E1035) � Wheelchair accessory — ventilator tray, gimbaled (E1030) � Water circulating heat pad with pump (E0217)

WA-NL-0309-19

Page 12 of 13

Coverage provided by Amerigroup Inc.

Medicare Advantage

Prepayment clinical validation review process View the article in the Medicaid section.WA-NL-0287-18

Provider payment schedule updates View the article in the Medicaid section.WA-NL-0301-19

Unspecified diagnosis code update View the article in the Medicaid section.WA-NL-0289-19

Coming soon: electronic attachmentsView the article in the Medicaid section.WA-NL-0300-19

AIM Specialty Health programs may require documentationView the article in the Medicaid section.WA-NL-0297-19

New service types added to Availity View the article in the Medicaid section.WA-NL-0292-19

Special needs plans — provider training required

Amerigroup Washington, Inc. offers special needs plans (SNPs) to people eligible for both Medicare and Medicaid benefits or who are qualified Medicare Advantage beneficiaries. SNPs provide enhanced benefits to people eligible for both Medicare and Medicaid. These include supplemental benefits such as hearing, dental, vision and transportation to medical appointments. Some SNPs include a card or catalog for purchasing over-the-counter items. SNPs do not charge premiums. As you are aware, CMS regulations protect SNP members from balance billing.

Providers who are contracted for SNPs are required to take annual training to stay current on plan benefits and requirements, including coordination-of-care and model-of-care elements. Providers contracted for our SNPs received notices in the first quarter of 2019 containing information for online, self-paced training through our training site hosted by SkillSoft. Each provider contracted for our SNPs is required to complete this annual training and select the attestation stating they have completed the training. Attestations can be completed by individual providers or at the group level with one signature.

AGPCRNL-0033-19

Page 13 of 13

Reimbursement Policy

New Policy Drug Screen Testing(Policy 19-001, effective 10/01/19)

Amerigroup Washington, Inc. allows separate reimbursement for definitive drug testing of 1-7 drug classes. Effective October 1, 2019, definitive drug testing for eight or more drug classes will not be

separately reimbursed when performed on the same date of service as presumptive testing.

Definitive drug testing may be done to confirm the results of a negative presumptive test or to identify substances when there is no presumptive test available. Provider’s documentation and member’s medical records should reflect that the test was properly ordered and support that the order was based on the result of the presumptive test.

In the event a reference lab (POS = 81) performs both presumptive and definitive tests on the same date of service, records should reflect that the ordering/treating provider issued a subsequent order for definitive testing based on the results of the presumptive tests.

For additional information, refer to the Drug Screen Testing reimbursement policy at https://providers.amerigroup.com/WA.WA-NL-0283-19

New Policy Emergency Department: Level of Evaluation and Management Services(Policy 19-002, effective 09/01/19)

Effective September 1, 2019, Amerigroup Washington, Inc. classifies the intensity/complexity of facility emergency department (ED) interventions used for services rendered with an evaluation and management (E&M) code level. E&M services will be reimbursed based on this classification at the highest E&M level supported on the claim. Facilities must utilize appropriate CPT/HCPCS and revenue codes for all services rendered during the ED encounter.

Please refer to the Emergency Department: Level of Evaluation and Management Services reimbursement policy for additional details at https://providers.amerigroup.com/WA.

Providers who feel that the level of reimbursement should be reconsidered can file a claims dispute in accordance with the terms of their contract. Claims disputes require a statement as to why the intensity/complexity would require a different level of reimbursement as well as the medical records, which should clearly document the facility interventions performed and referenced in that statement.WA-NL-0303-19