Providers and Partners

American Health Advantage of Missouri (HMO I-SNP) firmly believes that our success as a health plan hinges on our participating Providers. And we are committed to simplifying the administration of health insurance so our Providers can devote their attention to providing high-quality health care. We are always available if questions arise, and we collaborate with our Providers to help facilitate the efficient delivery of quality care to our Members.

For Prescribers and Pharmacies

American Health Advantage of Missouri provides Medicare Part D prescription drug coverage through our partner EnvisionRx. EnvisionRx is a full-service pharmacy benefit management company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.

For Prescribers:

    • Access Formulary and Prior Authorization Forms at www.envisionrx.com
      • Select “Prescribers” and click on “Prior Authorization”
      • Enter your NPI number and State to access the prescriber portal
    • EnvisionRxOptions Pharmacy Helpdesk
      • Phone number: 1-833-661-1990
      • TTY phone number: 711
    • Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

For Pharmacies:

    • Access payer sheets and other information at www.envisionrx.com
      • Select “Pharmacies” and click “Pharmacies Login”
      • Enter your NPI number and NCPDP number to access the pharmacy portal
    • EnvisionRxOptions Pharmacy Helpdesk
      • Phone number: 1-833-661-1990
      • TTY phone number: 711
    • Refer to the Prescription Drug Benefit page for formulary, prior authorization criteria, and step therapy criteria

Institutional Special Needs Plan Model of Care and Training

At American Health Advantage of Missouri, we specialize in improving health care and advancing a truly unique philosophy of care to meet the complex needs of the institutional Medicare beneficiary population, while simultaneously streamlining administrative functions for our Providers. The American Health Advantage of Missouri Model of Care focuses on providing a unique level of customized clinical care and services for residents in nursing facilities. As we help extend your care, our care model concentrates on addressing each Member’s full range of medical, functional, and behavioral health care needs in a coordinated and Member-centric manner. This means putting the Member’s preferences at the center of the care planning process and leveraging Provider resources to ensure every Member receives the services necessary to achieve their short-term and long-term care goals. Our model organizes best practices and industry innovations including:

    • The Advanced Nurse Practitioner (ANP) and Primary Care Physician (PCP) care team providing on-site, facility-based PCP support;
    • A risk-assessment tool designed for a nursing facility patient population;
    • A comprehensive history and physical assessment that generates an Individualized Care Plan (ICP);
    • A care management platform that helps identify needed preventive health/HEDIS services, ensures the use of evidence-based clinical guidelines, and facilitates care team communications for care coordination; and
    • Frequent face-to-face Member and caregiver/family member interactions that identify Member care preferences and allow time for important care decision discussions and counseling.

It is important that all of our Providers are properly trained and informed about the American Health Advantage of Missouri Model of Care. Our top priority is making sure all of the providers in the American Health Advantage of Missouri network meet the training and education needs of our institutional Medicare beneficiary population. The purpose of the Model of Care Training is to comply with the statutory requirement of the Centers for Medicare and Medicaid Services (CMS), that all Special Needs Plans provide a general understanding of the requirements of the Model of Care. In addition, this will also help you to seamlessly serve American Health Advantage of Missouri Members, your patients.

Become a American Health Advantage of Missouri Network Provider

American Health Advantage of Missouri contracts with physicians, facilities and other allied providers to ensure we have an adequate Provider network which is essential for the delivery of health care services to our members. All Providers must be credentialed before they can be added to our network as a participating Provider. Why Partner with American Health Advantage of Missouri:

    • From the beginning, physicians discover that American Health Advantage of Missouri isn’t just another Medicare Advantage health plan.
    • We have a different philosophy, attitude and approach to caring for our Members.
    • Our emphasis is on encouraging proactive health care and offering programs and services that can make a difference in our Members/your patients’ quality of life.
    • We strive to provide our Members exceptional benefits and an abundance of attention.
    • And we believe American Health Advantage of Missouri Providers deserve the same.

For more information on becoming a American Health Advantage of Missouri contracted Provider, please contact Network Operations at 1-844-228-7934; TTY 711 or via email at networksupport@amhealthplans.com.

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FAX UM Department: 1-800-513-0740

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