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  • Discharge Note Fax Form - Providers Amerigroup

Get Discharge Note Fax Form - Providers Amerigroup

Please fax this form to 1-877-434-7578 within one business day of discharge. Today s Date: Contact Information Member name: Member ID /reference number: Member date of birth: Member address: Member.

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Amerigroup will consider reimbursement for the initial claim, when received and accepted within timely filing requirements, in compliance with federal, and/or state mandates. Amerigroup follows the timely filing standard of 365 days for participating and nonparticipating providers and facilities.

Amerigroup will consider reimbursement for the initial claim, when received and accepted within timely filing requirements, in compliance with federal, and/or state mandates. Amerigroup follows the timely filing standard of 365 days for participating and nonparticipating providers and facilities.

Call Member Services toll free at 1-800-600-4441 (TTY 711).

Call Member Services at 1-800-600-4441 (TTY 711).

Your Payer ID is 26375.

Faxing the completed form to 1-844-490-4736 (for drugs under pharmacy benefit) or to 1-844-490-4870 (for drugs under medical benefit) Calling Provider Services at 1-800-454-3730.

Claim Filing Limits If Amerigroup is the primary or secondary payer, the time period is 180 days and is determined from the last date of service on the claim through the Amerigroup receipt date.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232