Amerigroup Participating Provider Agreement: Understanding the Basics

As a healthcare provider, understanding the Amerigroup Participating Provider Agreement is crucial in ensuring that your services are properly reimbursed and that you maintain a positive relationship with the insurance company. In this article, we will delve into the basics of the Amerigroup Participating Provider Agreement and what it means for you as a provider.

What is the Amerigroup Participating Provider Agreement?

The Amerigroup Participating Provider Agreement is a legal contract between Amerigroup, the insurance company, and the healthcare provider. This contract outlines the terms and conditions of the relationship between the two parties. By signing this agreement, healthcare providers agree to accept Amerigroup insurance and provide covered services to Amerigroup members.

What are the benefits of becoming an Amerigroup participating provider?

Becoming an Amerigroup participating provider comes with several benefits. One of the most significant benefits is having access to a large network of patients. Amerigroup has a substantial membership base, and partnering with them means that your services will be available to this vast population.

Additionally, becoming an Amerigroup participating provider allows you to gain access to many valuable resources and tools, such as online tools for claim submissions and customer service support.

What are the responsibilities of an Amerigroup participating provider?

As an Amerigroup participating provider, you have several responsibilities. These responsibilities include:

1. Providing medically necessary services: Amerigroup requires participating providers to provide only medically necessary services to their members. This means that providers must follow the Amerigroup clinical guidelines and ensure that the services they provide are appropriate and necessary for the patient`s condition.

2. Billing according to Amerigroup policies and procedures: Providers must follow Amerigroup`s billing policies and procedures when submitting claims. Failure to do so may result in claim denials or delays in payment.

3. Maintaining accurate records: Providers must maintain accurate and complete medical records for each Amerigroup member they treat. These records should include documentation of the care provided, as well as the patient`s medical history and any diagnoses.

What are the payment terms for Amerigroup participating providers?

Payment terms for Amerigroup participating providers vary depending on the specific agreement between the provider and the insurance company. However, Amerigroup typically pays providers on a fee-for-service basis for covered services. Providers are reimbursed at an agreed-upon rate, which may be lower than their usual fees.

Additionally, Amerigroup may require providers to submit claims electronically to ensure timely and accurate payment.

In conclusion, the Amerigroup Participating Provider Agreement is a critical component of the relationship between healthcare providers and Amerigroup. Understanding the basics of this agreement is crucial in maintaining a positive relationship with the insurance company and ensuring that your services are adequately reimbursed. By fulfilling your responsibilities as an Amerigroup participating provider, you can gain access to a large patient population and valuable resources and tools.