New Claims System Update

6.1 Enrollment and Eligibility Verification

Provider Manual
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6 PROVIDER NETWORK INFORMATION

6.1 Enrollment and Eligibility Verification

All health care providers are responsible for verifying enrollment and eligibility before services are rendered, except in the case of an emergency. In general, eligibility should be verified at the time of service and at least once monthly for ongoing services. In an emergency, eligibility should be determined as soon as possible after the member’s condition is stabilized. When a patient presents as a member, providers must verify eligibility, enrollment and coverage by performing the following steps:

  • Request the member’s IntegraNet ID card; if there are questions regarding the information, call       Amerivantage Provider Services at 1-866-805-4589 to verify eligibility, deductibles, coinsurance amounts,  copays and other benefit information or use the online provider inquiry tool        https://providers.amerigroup.com
  • If the patient does not have an ID card, use the Amerigroup online provider inquiry tool at         https://providers.amerigroup.com or call Amerivantage Provider Services at the DSU at 1-866-805-4589
  •   Copy both sides of the member’s IntegraNet ID card and place the copies in the member’s medical record
  •  Determine if the member is covered by another health plan to record information for coordination of         benefits purposes
  • If you are a PCP, check your IntegraNet Member Panel Listing via www.InetDr.com to ensure you are the       member’s doctor