New Claims System Update

To download a copy of Utilization Management FAQ, click here.

IntegraNet Health through our agreement with Amerivantage/Amerigroup & SCAN Health–all Medicare Advantage Plans for members of our Primary Care Physicians are delegated to IntegraNet Health for Utilization Management.

Providers are solely responsible for and are strongly encouraged to verify authorization requirements prior to rendering service.

Tips

  • Use Availity Provider Portal to verify eligibility and claims payor: https://www.availity.com/
  • Questions regarding the members Benefits Package contact Amerigroup: (800)-600-4441 or SCAN: (855)-844-7226
  • To verify provider network status with IntegraNet, visit our Provider Directory on our website
  • The IntegraNet Health Provider Portal is the preferred method of submission when requesting prior authorization.
  • Benefits of Portal Use

  • Eliminates faxes
  • Confirms receipt of the authorization request
  • Provides the ability to check authorization status in real time
  • Allows providers to

  • Upload clinical information to support medical necessity
  • Communicate with IntegraNet UM staff electronically
  • Print determination letters
  • Receive auto-generated approvals on select CPT codes
  • Prior authorizations denied for lack of medical necessity will be notified by phone of the determination and peer to peer with the Utilization Management Medical Director will be offered. Providers who wish to initiate peer to peer, have 24 hours from time of the notification to request peer review. Peer review can be scheduled by calling (281) 591-5289.

    Appeals for administrative denials (i.e. failure to obtain prior authorization, inappropriate level of care, late notification, or referral to an out of network provider) are to be submitted to:

    Appeals for lack of medical necessity denials are to be submitted to:

    Amerigroup:

    For a Fast Appeal

  • *Phone: 1-866-805-4589
  • *Fax: 1-888-458-1406
  • For a Standard Appeal

      Amerigroup - Medicare
      Complaints, Appeals, & Grievances
      4361 Irwin Simpson Rd., Mailstop OH025-A537
      Mason, OH 45040

    Scan Health:

    For a Fast Appeal

  • *Phone: 1-855-844-7226
  • *Fax: 1-562-989-0958
  • For a Standard Appeal

      Scan
      Attn: Grievance and Appeals Department
      P.O. Box 22644
      Long Beach, CA 90801-5644