Provider realtions for amerigroup

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In between credentialing cycles, Iowa Total Care conducts ongoing monitoring activities on all network providers. Staff will ensure that network providers have not incurred exclusions, licensure sanctions, illegal activity, or other negative indicators in between or prior to their standard re-credentialing through this monthly monitoring.

A provider's agreement may be terminated at any time if the Iowa Total Care Credentialing Committee determines that the provider no longer meets the credentialing requirements. This includes information obtained from any outside primary source such as the National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank, malpractice insurance carriers and state licensing agencies.

This does not allow a provider to review peer review-protected information such as references, personal recommendations, or other information. To request release of such information, a provider must submit a written request to the Iowa Total Care Credentialing Department at:.

Upon receipt of this information, the provider has 14 days to provide a written explanation detailing the error or the difference in information.

All providers who have submitted an application to join Iowa Total Care have the right to be informed of the status of their application upon request. In such cases, the provider has the right to request reconsideration in writing within 14 days of formal notice of denial. All written requests should include additional supporting documentation in favor of the applicant's reconsideration for participation in the Iowa Total Care network. The Credentialing Committee will review the reconsideration request at its next regularly scheduled meeting, but in no case later than 60 days from the receipt of the additional documentation.

Iowa Total Care will send a written response to the provider's reconsideration request within two weeks of the final decision. Federal regulations set forth in 42 CFR Representatives are assigned to specific regions. Provider Relations Specialists Territory Map. Be Well. Eat Well. Which providers must be credentialed? Information Provided at Credentialing. Credentialing Committee.

Committee meetings are held at least monthly and more often as deemed necessary. Louis, MO Upon receipt of this information, the provider has 14 days to provide a written explanation detailing the error or the difference in information. To obtain information pertaining to your network status, contact our National Provider Line at from 8 a. To request an administrative appeal, call the number included in the administrative denial letter you received.

Contact the Clinical Care Manager with whom you conduct reviews during absences i. Or call the number on the card to provide coverage information.

Mobile Site Search Search Field. Facebook Twitter LinkedIn. As a reminder, please ensure that you have completed your required Cultural Competency training. If you are a Practitioner, please visit CAQH, update your information, and attest that it is accurate. Provider Groups and Facilities may visit our provider portal or call our National Provider Service Line at to share your individual provider information.

Interested in joining the network? Follow the instructions on How to Become a Provider Claims — General Information If you have questions about claims in general, call Phone: from 8 a. ET, Monday through Friday Website: www.

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