Get Amerigroup Provider Forms

Completing the Amerigroup Provider Forms online is a straightforward process when you follow a few simple steps. This guide provides detailed instructions on each section and field, enabling you to update your practice profile accurately and efficiently.

Follow the steps to complete the Amerigroup Provider Forms online.

1. Press the 'Get Form' button to access the form and open it in the editor.
2. Begin with the provider information section. Fill in your provider name, select your gender, specify your specialty, and enter your license number.
3. Proceed to the location information section. Provide the site name and address, along with the office manager’s name, phone number, and fax number.
4. In the office hours section, indicate the hours of operation for each day of the week, and specify the age range of patients served by selecting the appropriate options.
5. Detail the languages spoken and confirm if your office is wheelchair accessible by selecting 'Yes' or 'No'.
6. For primary care providers, indicate your coverage type by selecting one of the available options for 24/7 coverage.
7. If applicable, address any changes to office locations. Provide the site name and address for new or additional locations and indicate if you wish to remove any existing office locations.
8. Fill out the billing information. Include a copy of the current W-9 form if there are changes, and indicate if there is a new tax ID number or billing address.
9. Complete the remaining fields for the tax ID number, billing address, contact person, and their respective phone numbers. Sign and print your name.
10. Finally, include the date you completed the form and ensure it is submitted to the designated Amerigroup address or fax number.

Complete your documents online today to ensure your provider profile is up to date.