Amerigroup update form 2026

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The document is a Practice Profile Update Form that allows healthcare providers to update their practice information, including provider details, billing information, office locations, and patient acceptance status. Providers are instructed to fill out only the sections where changes have occurred and must fax the completed form to the Provider Relations department. Key requirements include completing the Provider Information section, signing and dating the form, and attaching a current W-9 form for billing changes.

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Click ‘Get Form’ to open the amerigroup update form in the editor.
Begin by filling out the Provider Information section. Enter your name, select your gender, and provide your specialty, license number, and NPI.
Indicate what type of information you are updating by checking all applicable boxes such as billing information or office hours.
In the Practice Details section, specify your office hours for each day of the week and indicate the age range of patients served.
Complete the Primary Care Provider Details section, ensuring you mark your coverage type and whether you are accepting new patients.
If updating billing information, attach a current W-9 form and fill in any changes to tax ID numbers or billing addresses.
Finally, sign and date the form before submitting it via fax to ensure your updates are processed.

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What is the phone number for Amerigroup provider portal?

Visit our website at . If you are unable to access the Internet, you may receive claims, eligibility and authorization status over the telephone at any time by calling our toll-free automated Provider Services line at the DSU at 1-866-805-4589.

How to check Amerigroup eligibility?

Check Your Eligibility Visit the Amerigroup website or your states Medicaid portal to see the exact income limits and other qualifying factors.

How do I submit a claim to Amerigroup?

AVAILITY (282.4548) or contact your Foundational Community Supports (FCS) Manager at 1-844-451-2828. Log In to Availity Enter User ID and Password. From the menu bar select applicable State from the right dropdown arrow. Navigate to Claims Payments Claims then select Professional Claim or Facility Claim.

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What are Amerigroup insurance providers?

Amerigroup is a leading managed care company dedicated to improving lives and promoting healthier communities. We are making health care simpler for individuals served by Medicaid, State Childrens Health Insurance Program and other State-sponsored health programs. We also serve individuals who are Medicare-eligible.

Amerigroup update form 2026

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