Special free services for our members - Providers - Amerigroup
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Special free services for our members
Educational and Pregnancy support
advocacy support
Taking Care of Baby and Me®
Free GED testing program
For members 17 years of age and This program provides educational tools and
older, Amerigroup Washington, support during pregnancy and throughout
Inc. pays the four required the postpartum period. Additionally, the
modules of GED testing once program offers incentives to pregnant
per member lifetime. This benefit is accessed members for attending healthy activities
through coordination with local community such as prenatal and postpartum visits.
colleges. Amerigroup works with the school to
verify eligibility and arrange payment. To help My Advocate®*
members learn more, advise them to contact This component of our pregnancy support provides
Member Services at 1-800-600-4441. health education by phone, text message, smartphone
app or web. Pregnant women will get to know
National disability advocacy Mary Beth, My Advocate’s automated personality.
organizations Members can complete an initial health screening
related to their pregnancy and then receive prenatal
Members with disabilities may enroll in an
educational messages related to each stage of
annual membership to one of four national
pregnancy. When members tell Mary Beth they have
disability advocacy organizations:
a problem, a prompt callback is initiated by one of our
■ Autistic Self Advocacy Network
case managers.
■ American Association of People
with Disabilities
■ National Council on Independent Living Prenatal ultrasounds
■ TASH We cover two routine prenatal
ultrasounds for fetal anatomic survey
per pregnancy (CPT® codes 76801
and 76805); no authorization is required. Additional
ultrasounds for CPT codes 76811, 76812, 76815, 76816
and 76817 for suspected maternal/fetal abnormality or
follow-up require an appropriate diagnosis indicating
medical necessity to be reimbursed. Authorization is
not required. These limits do not apply to hospitals,
maternal fetal medicine or radiology providers.
Review our policy on prenatal ultrasounds using our
Quick Tools menu to access medical coverage policies
on our provider self-service website
(https://provider.amerigroup.com/wa).
Electric breast pumps
Moms may receive one electric breast pump per their
lifetime without need for prior authorization. Providers
simply submit the request form to our sole source
provider, Medline,* denoting the member’s choice
between Medela In Style Advanced personal double
breast pump or one of the Ameda Purely Yours pumps.
Just for kids Newborn circumcisions We pay for newborn circumcisions up to $150 for members. Use CPT codes 54150, 54160 or 54161. Sports physicals We pay in-network primary care providers for performing sports physicals once per year for our members ages 7 to 18. Use current CPT code 99212 with DX Z02.5 when you bill. You can bill for both a wellness visit and a sports physical on the same day by including modifier 25. Same-day well-child and sick visits We pay for sick visits and complete preventive well-child assessment visits on the same day. Use evaluation and management (E&M) CPT codes for the level of complexity combined with the age. Bill with the age-appropriate Early and Periodic Screening, Diagnostic and Treatment (EPSDT) service codes (99381-99385 and 99392-99395) using one of the appropriate sick visit E&M codes with modifier 25. Allowable sick visits are limited to the following: ■ A minor (e.g., 10 minutes) new patient E&M visit ■ A minor established patient E&M visit ■ A minimal (e.g., five minutes) established patient E&M visit When modifier 25 is not billed appropriately, the sick visit is denied. Appropriate diagnosis codes must also be billed for every visit. Same-day wellness visits are not applicable to the After Hours Care program; after-hours care is for sick visits only. Boys & Girls Club free membership This service is available in each of the state locations for members ages 6 to 18. Healthy Families program We give families with children ages 7 to 13 coaching and support on nutrition and physical activity.
Adults — filling the gaps
Eyeglasses Car seat
Members ages 21 to 64 are covered Car seat benefit is available to pregnant members
for one pair, once a year, up to $100. This service is and new moms and babies up to 12 months. This
available through EyeQuest,* our eye care vendor. benefit helps members by promoting and ensuring
safety for their newborn child. Limit one per
member per year.
Acupuncture
Amerigroup pays for seven acupuncture visits per Transportation services
calendar year, per member aged 18 years and older, Members receive a nonmedical
with contracted providers. Providers must use the transportation benefit to help
following codes: them access services including getting to school,
■ 97810: Acupuncture, one or more needles, work, job interviews, getting kids to daycare and
without electrical stimulation, initial 15 minutes other services.
of personal one-on-one contact with the patient;
Amerigroup fixed price of $30 Members should call the National Call Center, verify
■ 97811: Each additional 15 minutes of personal mailing address and report the service they are
one-on-one contact with the patient, with trying to access. An Orca card or gas card will be
reinsertion of needles; Amerigroup fixed price of mailed to the member (18 years or older).
$30
■ 97813: Acupuncture, one or more needles, One-time only benefit
with electrical stimulation, initial 15 minutes of Members will receive one of the following:
personal one-on-one contact with the patient; ■ $50 choice Uber/Lyft card — once per year
Amerigroup fixed price of $50 ■ $50 Gas card — once per year
■ 97814: Each additional 15 minutes of personal ■ $50 King County Orca card
one-on-one contact with the patient, with
reinsertion of needles; Amerigroup fixed price of
$50
Tobacco cessation
All members ages 18 years and
older may enroll in Quit for Life, the
Costco membership
state’s tobacco cessation program.
Members can receive a one-year Costco Members enroll by phone at 1-866-QUIT-4-LIFE
Gold Star membership. This membership is a (1-866-784-8454) or online (https://quitnow.net).
household card and valid at all Costco locations. Amerigroup provides additional resource
Only one membership per family is available. information and local tobacco cessation program
Members should call the National Call Center at promotion via collaborative partnerships.
1-800-454-3730 to request, verify their address
and report the benefit they are trying to access. Amerigroup also pays PCPs for smoking cessation
The Costco Gold Star membership card will then be referral evaluations, smoking cessation prescription
mailed to the member. evaluation and face-to-face counseling for all
members ages 18 years and older:
Flu Pandemic kit ■ Intensive smoking cessation counseling
(procedure 99407 for greater than 10 minutes) is
Flu Pandemic kit benefit helps members to remain limited to one per day.
prepared for the next flu season or pandemic. The ■ Two cessation counseling attempts (or up to
kit may include essential and preventive safety eight sessions) are allowed every 12 months.
items such as face masks, hand sanitizer and wipes. An attempt is defined as up to four cessation
Limit one per member per year. counseling sessions.Staying fit
Weight Watchers®* Focusing on mental health is important, and our
program includes web and mobile resources to
Members can receive one Weight help strengthen mind, body and spirit. Our program
Watchers voucher good for sign-up includes a dynamic, personalized website that
fee and 13 weeks of classes and offers clinically proven mental health applications
14 weeks of Digital Tools. They must be over to help with mental health challenges using tailored
age 17 and get permission from their doctor. wellness resources. Our self-help resources help
ensure our members can be active participants
FitnessCoach Program in their journey to becoming — and staying —
Services include online exercise classes and online mentally and physically healthy.
information on fitness and exercise topics, including
information available to special needs populations. Peer-to-peer counselor
benefit
Light Box for seasonal Certified peer counselors work
affective disorder (SAD) with their peers (adults and youth)
Members must be diagnosed with SAD and the parents of children receiving
to be eligible. mental health services. They draw upon their
experiences to help peers find hope and make
No preauthorization is required; however, members progress toward recovery. Because of their own life
with past or current eye problems, such as experience, they are uniquely equipped to provide
glaucoma, cataracts or eye damage from diabetes, support, encouragement and resources to those
must get advice from their eye doctor before with mental health challenges.
starting light therapy.
Washington state's Peer Support Program has
Life Transition Kit trained and qualified mental health consumers as
certified peer counselors since 2005. A consumer
A Life Transition Kit includes: first-aid supplies is someone who has applied for, is eligible for
such as bandages and ointment, toothpaste, travel or who has received mental health services.
toothbrush, mouthwash, dental floss, and a This also includes parents and legal guardians
$15 Subway gift card. when they have a child under the age of 13, or a
This benefit is intended to help members get back child 13 or older when they are involved in their
on their feet more quickly when transitioning out treatment plan (Washington Administrative Code
of an institutional setting or for anyone enrolled in 388-865-0150).
supportive employment. Members can contact Member Services to request
payment for the program. Member Services will
MyStrength™ contact David Escame at the health plan,
MyStrength is an online well-being program that david.escame@amerigroup.com:
offers web and mobile HIPAA-compliant tools to ■ $60 initial registration fee
help members with emotional health issues such as ■ $50 annual renewal fee
depression, anxiety, stress, and misuse of drugs and ■ $110 total unit cost
alcohol. It allows eligible members to take an active
part in improving their health and well-being.Online and mobile resources End of life
Amerigroup On Call Vital decisions
Members may speak to a nurse about medical questions This program provides telephonic health
or concerns, day or night, even on holidays. Translation care counseling service for members who
services are available for more than 150 languages. are within approximately 6 to 9 months from
end of life. The program consists of a series
SafeLink®* of telephone counseling sessions with an
individual counselor to educate and coach
Qualified members may secure a cellphone with up
members to become more active participants
to 350 free minutes of service each month, plus the
in healthcare and end-of-life decision making.
member may be eligible for the following:
Amerigroup identifies potential participants
■ 200 extra one-time bonus minutes when the member
through medical and pharmacy claims. If
chooses to receive free health text messages
providers wish to refer members to this
■ Unlimited wellness text messages from Amerigroup,
optional program, they may contact our case
plus reminders to renew benefits on time
managers at 1-800-454-3730.
■ Unlimited minutes when calling our Member Services
department and Amerigroup On Call
Additional resources
Members enrolled in Case Management and
enrolled in SafeLink will receive a monthly
8.5GB, unlimited talk, unlimited text plan.
First-aid kit and dental
hygiene kit
Note: SafeLink Wireless® is a Lifeline-supported service.
These kits are available for free when a
Lifeline is a government benefit program. Only those
personal disaster plan is completed online.
who qualify may enroll in Lifeline; it can’t be transferred
and is limited to one per household. Members may need
to show proof of income or that they take part in the Disease management education
program to enroll. and support
This support program is designed to help
Amerigroup mobile ID card and app manage difficult health conditions like
Members may use this feature to safely access ID cards, asthma, diabetes and chronic obstructive
find a doctor and increase access to health resources. pulmonary disease.Healthy Rewards
The Healthy Rewards program at Amerigroup is designed to encourage members to get the care they need and
earn rewards for completing eligible activities, while helping to increase provider’s quality scores. All activities
are tied to HEDIS® or health iniatives.
Members must be enrolled in the program to earn rewards, and once a claim is received for a qualifying
activity, the reward loads to the member’s Healthy Rewards online portal account and can be redeemed for a
variety of popular retail gift cards such as Amazon, Kohl’s, Subway, TJ Maxx and more.
Healthy activity Who’s eligible Reward Limit
High Blood Pressure Medication Refill M, F, ages 18 to 75 $10, max $40 1 per quarter
Child and Adolescent Wellness Visit M, F, ages 3 to 21 $25 1 per 12 months
M, F, ages 0 to 1
Childhood Immunization Status — Combo 10 $25 1 per member
(stops at 2nd birthday)
Chlamydia Screening F, ages 14 to 24 $25 1 per 12 months
Breast Cancer Screening F, ages 50 to 74 $50 1 per 24 months
Asthma Management M, F, ages 6 and older $10, max $40 1 per quarter
ADHD Medication Refills M, F, ages 6 to 12 $10, max $40 1 per quarter
Mental Health Engagement M, F, ages 6 and older $10, max $40 1 per quarter
Mental Health Treatment — Medication Refills M, F, ages 6 and older $10, max $40 1 per quarter
Substance Use Disorder Engagement M, F, ages 12 and older $10, max $40 1 per quarter
Substance Use Disorder Treatment — Medication Refills M, F, ages 12 and older $10, max $40 1 per quarter
Diabetic Retinal Eye Exam M, F, ages 18 to 75 $25 1 per 12 months
1st Prenatal Care Visit F, ages 13 to 55 $20 1 per pregnancy
Ongoing Prenatal Care Visit (6 visits) F, ages 13 to 55 $5, max $30 1 per pregnancy
Postpartum Care Visit F, ages 13 to 55 $25 1 per pregnancy
For additional information or to enroll in the program, please encourage members to visit Healthy Rewards at
https://www.myamerigroup.com/wa or call 1-888-990-8681 (TTY 711) Monday to Friday 6 a.m. to 5 p.m. PT.
Contact information
To find out more about these special services, please call your local Provider Experience consultant or
our Provider Services team at 1-800-454-3730.
Members can call 1-800-600-4441 or TTY 711 to learn more about the benefits listed above.
HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
* Change Healthcare is an independent company managing the My Advocate program on behalf of Amerigroup Washington, Inc.
Medline is an independent company providing electric breast pumps on behalf of Amerigroup Washington, Inc. EyeQuest is an
independent company providing eye care services on behalf of Amerigroup Washington Inc. Weight Watchers is an independent
company providing nutritional education services on behalf of Amerigroup Washington, Inc. SafeLink Wireless is an independent
company providing wireless communication services on behalf of Amerigroup Washington, Inc.
Please note: This flier is intended for educational use to providers and community organizations. This is not for public distribution.https://provider.amerigroup.com/wa WAPEC-2811-21
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