Amerigroup PAN Update Effective June 1, 2017

Summary of change:

Effective June 1, 2017, the Nonemergent Medical Transportation (NEMT)Form will require the inclusion of diagnosis codes, procedure codes and supporting clinicaldocumentation.
What is the impact of this change?
Providers requesting NEMT must include the ICD-10 codes, CPT codes and supporting clinical
documentation on the completed NEMT Form. If the NEMT Form is submitted without this
information, the request will be returned as an incomplete request.
What authorization form do I use now?
Complete the NEMT Form (located at It is important to fully complete the form and provide all supporting clinical documentation. NEMT Forms without the required documentation cannot be processed. This information can be submitted electronically on the provider website or via fax at 1-866-249-1271.
What will I receive from Amerigroup after I submit the NEMT request?
Amerigroup will fax the Amerigroup NEMT request authorization number to the requesting provider. The fax will provide information on services fully approved or denied.

What if I need assistance or have questions related to this change?
If you have questions about this communication, received this fax in error or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 1-800-454-3730.

Amerigroup Update June 1 2017

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