Get 866 249 1271 Amerigroup

The 866 249 1271 Amerigroup form is essential for submitting a therapy preauthorization request. This guide will help you navigate each section of the form with clear instructions, ensuring a smooth completion process.

Follow the steps to fill out the Amerigroup therapy preauthorization request form online.

1. Press the ‘Get Form’ button to acquire the form and access it in the online editor.
2. Complete the 'Vendor Information' section by entering your name and contact details.
3. Fill in the 'Member Information' with the member's name, ID number, Amerigroup number, date of birth, phone number, and NPI + TPI number.
4. In the 'Services Requested' section, provide the frequency and dates of service.
5. Enter the appropriate CPT/modifiers and HCFA codes for physical therapy (PT), occupational therapy (OT), and speech therapy (ST).
6. Indicate the number of pages you are faxing as part of the request.
7. Ensure to include the applicable billing CPT codes and a physician's order with all submissions.
8. Attach any clinical updates or progress notes towards the therapy goals.
9. For requests involving standardized tests, remember to include standardized test scores for additional visits.
10. After reviewing your entries for accuracy, you can save your changes, download the completed form, print it, or share it as required.

Complete your documents online to ensure timely processing and authorization.