Candace [email protected] >

t. Lany Brown, Team Lead for the Care Coordination Teams
Email: [email protected]<mailto:larry.brown(g)amerigroup.com>
Office: (678) 587-4859
2.
Alison Barreiro-Jones is the mgr for the northern part of the state, Regions 1 & 2.
Email : Allison.ban'eiro-j ones@ameri group. com
<mailto:Allison.b
Office: (678)583-5061
Cell: (470) 362-1209
3.
candace Body is the mgr for the metro area east and west, Regions 3,5, 14 & 15
Candace
[email protected]<mailto:Candace.b
>
Office: (678) 587-4811
Cell: ((404) 242-6735
4.
Tonia Richardson is the mgr for the southern part of the state, Regio ns 4, 6, 7 , g,
11, 12, 13
[email protected]<mailto:Tonia.ric
Office: (678) 587-0531
CeIl: (470) 362-1541
>
g
,
10,
Georgia Families 360" Care Coordination Teams
Team
1
DeKalb & Fulton Counties
Last Name
First
Position
Phone Contact
Tatum
Trina
RN
470-336-0980
Email Contact
Trina.Tatum @amerigrou p.com
Linen
Marcus
CM
470 554-4549
Marcus.Linen @amerigrou p.com
Toney
Monica
CM
470-554-2520
M o n i ca.To neu@
Cream
Ashleigh
CM
404-242-51.80
Ashleigh.Cream@a merigroup.com
Robi nson
Louquitta
CM
470-723-4547
Louq
Joh nson
Tiffany
CM
470-328-3942
Tiffanv.Johnson @amerigroup.com
McLean
Tiffany
CM
Pending
u
a ryr g_Ji
gro
u p.
com
itta. Robinson @a merigrou p.com
[email protected]
Team 2
Floyd, Bartow, Cherokee, Polk, Paulding, Cobb, Haralson, and Douglas
Last Name
First
Position
RN
Phone Contact
470-336-0373
Ciaudia.GaVle@a merigrou p.com
CM
470-385-s583
La
Patrice
cc
470-328-4123
Patrice.mcclinton @amerigrou p.com
Thomas
April
CM
470-723-4166
[email protected]
Smith
Angela
cc
470-328-1286
Angela.Srnith @amerigroup.com
Hammontree
Amber
CM
470-554-6094
Amber.
[email protected]
Gayle
Claudia
Wilcox
La
McClinton
keisha
Email Contact
kesha.Wilcox@amerigrou p.com
Georgia Families 360" Care Coordination Teams
Team 3
Gwinnett, Barrow, Clarke, Elbert, Greene, Jackson, Jasper, Madison, Morgan, Newton, Oconee, Oglethorpe, and Walton
last Name
Gerard
Agnew
First
Position
Jennifer
Crysta
Phone Number
470- 554-7894
[email protected]
470-362-8591
Crvsta l.Agnew@
470-362-9488
Mega n.Todd @amerigrou p.com
470-38s-5752
Cody. [email protected]
470-362-8881
Antoinettte.McClellan
CM
a
merigroup.com
CM
I
Todd
Megan
CM
Jea n
Cody
CM
McClellan
Antoinette
CM
470-554-4499
Muhammad
Email Contact
Timeka
@a
merigroup.com
Timeka.Muham mad @amerigroup.com
CM
Team 4
Dade, Catoosa, Walker, Gordon, Gilmer, Fannin, Murray, Whitfield, Pickens, Union, Dawson, [umpkin, White, Habersham,
Towns, Rabun, Stephens, Franklin, Hart, Banks, Hall, Forsyth, Jackson, Barrow, Oconee, Clark, Madison, Elbert, Oglethorpe
Last Name
First
Position
Phone Contact
Email Contact
Rea
LeAnn
CM
706-340-4271
[email protected]
Brown
rikki
CM
770-912-6347
Tikki.Brown @amerigroup.com
Higgs
MallerV
CC
678-524-4033
[email protected]
Johnson
Ayaana
cc
404-578-3600
[email protected]
Doe
Karla
CM
Pending
Karla.doe@amerigrou p.com
Georgia Families 360" Care Coordination Teams
Team 5
Clayton, Henry, Rockdale, Baldwin, Bibb, Crawford, Houston, Jones, Monroe, peach, putnam, Twiggs, Wilkinson, Butts,
Carroll, Coweta, Fayette, Heard, Lamar, Meriwether, Pike, Spaldin g,Troup, Upson
last Name
Garrett
First
Position
Phone Contact
Email Contact
Veronica
CM RN
470-336-0762
Veronica.Ga rrett@a me rigroup.com
Burns
Shundra
CM
470-554-5443
Sh
Meyers
Nadine
CM
Burns- Jackson
Wanda
CM
478-221,-0827
wa nda. burnsiackson @a merigroup.com
nifer
CM
470-328-3530
Jennifer. Benton @amerigroup.com
CM
470-767-1,410
TracV. Krista [email protected]
Benton
Kristila kis
Jen
Tracy
678-519-7523
und ra. Bu rnes(da merigroup.com
Nadine. [email protected]
Team 5
Burke, Columbia, Glascock, Hancock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Screven, Taliaferro, Warren,
Washington, Wilkes, Bryan, Bulloch, Camden, Chatham, Effingham, Glynn, Liberty, Long, Mclntosh, Appling, Bleckley,
Candler, Dodge, Emanuel, Evans, Jeff Davis, Johnson, Laurens, Montgomery, pulaski, Tattnall, Telfair, Toombs, Treutlen,
Wayne, Wheeler, Wilcox
Last Name
First
Wynn
LaVonne
Norfleet
Aungelia
Position
Phone Contact
Email Contact
CM
470-328-4812
Lavo n ne.Wvnn @a merigroup.co m
404-484-5053
Au ngel is. N orfleet (da me rigro u p. co m
RN
CM
Georgia Families 360" Care Coordination Teams
Dean-El
Vontija
CM
470-554-6273
Spivey
Angela
CM
912-271.-3863
An ge la. Spivv @
Reese
Glen
CM
470-554-4338
Glen. [email protected]
Brown
Brea n na
CM
Pending
Vontiia. [email protected]
B
a rn e
rig ro u p. co rn
rea n na. b rown @a m e rigroup. co m
Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marion, Muscogee,
euitman, Randolph, schley, Stewart, Sumter,
Talbot, Taylor, webster, Baker, Calhoun, Colquitt, Decatur, Dougherty, Early,
Grady, Lee, Miller, Mitchell, Seminole,
Terrell, Thomas, Worth, Atkinson, Bacon, Ben Hill, Berrien, Brantley, Brooks, Charlton,
Clinch, Coffee, Cook, Echols, lrwin,
Lanier, Lowndes, pierce, Tift, Turner, Ware
Fre nch-
H
ines
S. Michelle
229-338-606s
470-554-4652
Williams
229-221"-1,452
I
[email protected]
[email protected]
[email protected]
404-851,-7991
Belinda. mosbv@a merigroup.com
tl
{
o
o
UJ
O
(/.) (JJ UJ
N) N) N) N) N) N) NJ NJ N) NJ
N)
{
oo
o\
d
o
CD
F
5
o\ o\ o\ o\ (^
UJ NJ
\o
I
(/)
o
CD
(,It
u
NJ
J-.t
a
(^ 5
(J)
B
E
4
o o
o
o
'/\ d
,f
a o o
o
t0
o o
\o
N)
r-t
r-
oo
{
o\
FD
TD
TD
E
E
F-.1
+i o
H
(D
() 5
u.) N)
!
p w
FD
()
CD
>-t
v)
a
Iq
1.1
o
2.
i
I
(D
(D
(D
V)
@
tD
o
o
Ia
ts1
H
ts-t
ID
(D
FD
SD
ts-t
(D
r-t
{
oo
N)
oooooooooooooo
lo
(a
le !o
o
a gts
,f 4
o
5
(4
CD
3
A u)
Lar
'L)
f-l
F
B
FD
c/)
o-
() o
o B
tf
o
u () Lrr
{ o\
s
LA (.rr
oo
(..l
r
H
o
,-t
'r)
'f I
tD
U)
())
H
lal
d
(rr
A
\o
(Jt
(r.) N) v
f-l
Iq
s.\
[1J
-
TD
ts-t
o
o
IA
(t
(t
CD
I
Ia
c)
li
CD
B
o-
- rr TD
B
(D
rD
Li
H
(D
(D
ch
r.
TD
f+
Li
o
o
Li
CD
'a\
-o+
*(D'
o
a
FD
t
(]) (/J
F
Lll
\)
o\
ooo
o
O
ooooo
.o :*r
-2.
o'
\o
r-t
v)
tJ
r-l
CD
!
\o
Li
Li
.+
F-D
c0
(A
(D
(D
t-t
v)
U)
a
Iq
Ta
o.
.D
tL)
(Jr
oo
f-
ND
UJ UJ (JJ tJ)
o
+
b'
4
o
A
(JJ
(a
A)
i
a
\)
CD
() 5
i-)
O
5 5 5 A
UJ N)
o o
a- ,A o
gD
oo oo oo oo oo oo @ oo oo oo
oo
o\ Lfr 5 UJ N)
O
? 7 7 - - - rr -
o (,
o
@
tD
5 5 5 5 ()
A
oo !
o\
\o
(D
tsl
8D
[11
Hi o
H
CA
(D
7\
\o
rn rn
+
[ 1.]
(D
Lh (-,\
F-.t
U)
o
\t
oo
{{ {o\ (^
{ {s {UJ {NJ { \)
o
ts +i F F -r
(D
(D
a
a
F,t
9D
'a\
Fl
90
F+
ts
fi
SD
F.t|
E
F-l
ED
v)
(A
o\
\o
FTr
oo
+r
c'
o
TD
o
{
o\ o\
o\ Lfi
{
t-t
F-t
(t
C)
o
(D
H
-
z
U
o aCD
-J
iJ
NJ N) NJ NJ
\t o\
(Jl
t.)
A
a (, (, a
a
o o
o
{ ) 9B
(D
F-t
NJ NJ NJ
UJ N)
(n
C)
(D
IO
()
(D
ts
(D
rD
a
F
o
(D
t\)
O
tD
a
oo
F
gD
ct
iJ
(,
\)
o\
ci+
U
o n (D ()
Ta o
B
(D
o
()
2f
o (D iJ o. o
tt
(D
o
cD
gD
ID
Lat
A
O
N)
oo
CD
U)
TA
CD
{
5
UJ N)
z7 7
7
7 7 7
CD
(Jl
oo
Lar
\)
q
o\
(,
(.rl
(,rr
A
..
-/.
E
(D
(t
a
q (A Llr
u) N)
:i
c)
X
+
CD
d
(D
(.n
r'.
j.
@
(t
-
o a
o
o o
o
t-t F-t
-
(D
i+)
H
ts-t
J
TA
s
Lar
H
@
tD
U)
o
tst
a E
JJ
ts1
CD
ts
Ia
o
o
.D
o o
o ts
t,
\)
u)
o\
F-t
Iq
(D
U)
'-t
CD
et/
(t
a
a
-J
CD
B
B
(D
{
H
7?
7
o
o
o o
B
H
{
(D
r-
UJ U) U) t,
(Jl
oo
(D
F-t
o 4 o
5
;J
Ia
H
@
-l - -l -l a *l +
H
IA
o
Iq
B
5 s 5 5 |+.) t/)
\o oo
A (/) NJ
q
o
o
0q
5 5
5 A
oo !
o\
d
o
.D
(^
\o
\o
(rr
)a
(,
.+
t}
Ir]
c
z
-l
s
(/J
N.)
-l
-j
-l -l -l a o
H
o
ts
*
t0'
CD
(J)
N) Lrl
\o
sD
lD
2
a
o
c4 c
U)
oo
C
u JJ
o (!
+
CD'
t0
t4
B
r-t
-l
I
z
Amerigroup GA Families 360" DFC$ Referral Form
submit this form to AGP, DCH and Rev Max for any Georgia Families 360" action indicated by checkboxes
below. complete each section of this
form prior to submitting. submit completed form by sending email to all 3 email addresses listed: [email protected]
FCFTAOJi*Memheir'Serviees@dei,
r,!=cJs_JL,,.sa.6us
.ga.gov;, ftssr?i6AL,y!u
Revfliiaxe [email protected]
! rdfrst!.t{rr}€treilf.sE;l{e.ga.{J5 Fax torm
form
{:
;
to Amerigroup
to
A
at ggg_375_5064 if not emailed.
* sheck sme
tr Ghild Enters CareiGustody trGhange in Placement trGhild leaving DFGS Gustody trUpdate ncM Ghange
seetlean
ffi,eascm fon ffio*gffrce€Esffi €* s"smerggtrs&*p
Current Date:
Name of Person Completing Form:
Section 2: lnformation about the child: This section must be
Child's Name:
Medicaid lD #:
Section 3; lnformation about the child's case worker: This section must be
DFCS Case Manager Name:
Case Manager Contact Number/email
Date Entered Custody:
Joint Custody: Y/N
address:
County Office Address:
Section 4: lnformation about the child's current placement: This seciion ;ust b" .o*pteted
Placement Provider Name :
Placement Provider Address :
Placement Provider Telephone Number (if available):
Placement Provider Email (if available):
lnformation about the child's future placement: Complete this section if the child has a change in placement
New Placement Provide Name :
Date the Child Will Move to New placement:
DFCS
New Placement Provider Address:
New Placement Provider Telephone Number (if available):
Placement Provider Email (if available):
Section6:lnformationaboutachildleavingDFcscu5tody:Completeitttrecr'@
Date child will leave foster care:
Reason for Leaving Foster care (aging out, custody to someone, guardianship to someone):
Section7:lnformationaboutthechild,smedicalneeds:Completeiftnectr
Emergency Care Needed? yes No
Emergency Medications Needed? yes
lf yes, explain (include name of facillty and
No
lf yes, specify drug and pharmacy:
treatment needed):
5ection8lListallreferralsthathavebeenmadesincechildtakenintelcustoo
any other healthcare services etcl:
Reason for Referral (BCW,
CCF
Date of Referral
aldiagnosislconditions,i'e.nouoJnXietyciscrdeieic
$e*c*, 3€:''rill*di*gti*is
Medication Name
tti:sr rU fi€dicart€lis
*"t
tne Arlr,f is
How often is this taken
Usethisformfor:intakeorentryintoFc;placementchange;.h"nJ-inorcscasetvtan"g"'(
Version: v03-17
Reason
for Medication
Families:nn:
Georgia Families 360" Resource lnformation
Questions from Adoption Assistance parents or members about enrollment, opting inf out, primary care
providers, primary dental providers, scheduling appointments, provider network:
Amerig rou p I nta ke
Li ne
:
855.66L.2021 (phone)-- DcH may 'warm transfer' calls to the lntake Line
888.375.s06a (fax)
[email protected] xfor member documents only* (email)
Questions from Foster Care parents or members about enrollment, primary care providers, primary dental
providers, scheduling appointments, provider network:
Ame rig rou p Inta ke Li n e :
855.661.2021 (phone) -- DcH may 'warm transfer' calls to the lntake Line
888.375.s064 (fax)
[email protected] *for member documents only* (email)
Questions from Juvenile Justice parents or members about enroltment, primary care providers, primary
dental providers, scheduling appointments, provider network:
Amerig rou p I ntoke
Li ne :
855.661.2021 (phone) -- DcH may 'warm transfer' calls to the lntake Line
888.375.s064 (fax)
[email protected] *for member documents only* (email)
Questions or concerns from members about health care related issues or program services:
Ombudsmon Program:
Amerigroup:
1-855-558-1436 (phone)
helpOM 3(damerigroup.com (email)
1-888-375-5067 (fax)
DCH:
GeorgiaFamilies36C [email protected]
Amerigroup
$Wmm$S$ru]uffiffijxj
i"^^1+l^-..-*^
i i Udl Li !L d,r- e
Amerigroup ID card
S
*"*0"'
==-
to
For starters, to view, print or change a doctor, you,ll need the member,s:
s Medicaid lD number
.fr Last name
fl: Date of birth
$l ZIP code
once you've received this information, visit wu/w.myamerigroup.com and click on
Register Here to create a username and password to view the member's information.
View and print ID card
it
Log in to view andlor print the lD card
Click on lD card
Click on View and Print
To request an lD card by phone, please call the Georgia Families 360",, Member lntake
Line at 1.-855-661,-202L
Change primary care provider (pCp)
i,rl Log in to change the PCp
Click on My Account
Click on Your Primary Care provider to make changes
Choose a PCP from the search page
Click on Change to your pCp
To change a PCP by phone, please call
the
Georgia Families 350",, Member lntake Line
at 1-855-66 L-Z0ZL (TTY 1-800-855 -zgS0).
Ceorgi
Families 360:-
Amerigroup
ffimmKffimlmtfmmm
.iieal.thcare
Tarjeta de identificacion de Amerigroup
Para principiantes, para ver, imprimir o cambiar un doctor, necesita16 la siguiente
informaci6n del miembro:
& NUmero de identificaci6n de Medicaid
i,i Apellido
&u Fecha de nacimiento
lu C6digo postal
Una vez usted haya recibido esta informaci6n, visite www.myamerigroup.com y haga clic
en Register Here (Registrese aqui) para crear un nombre de usuario y contrasefia para ver
informaci6n del miembro.
la
Ver e imprimir la tarjeta de identificacion
s* lnicie sesi6n para ver y/o imprimir la tarjeta de identificaci6n
Haga clic en lD card (Tarjeta de identificaci6n)
Haga clic en View and Print (Ver e imprimir)
Para solicitar una tarjeta de identificaci6n por tel6fono, llame a Georgia Families 360",, Member
lntake Line al I-855-661-2021,.
Cambiar el proveedor de cuidado primario (pCp)
W
',]
fr
1{
*.fwr'o"
/
,u
-
hffi$'
iW
MT\i
..
lnicie sesi6n para cambiar su PCp
Haga clic en My Account {Mi cuenta)
Haga clic en Your Primary Care provider (Su proveedor
de cuidado primario) para hacer cambios
Elija un PCP de la p6gina de b0squeda
Haga clic en Change to Your pCp
(Cambiar su PCP)
Para cambiar un PCP por tel6fono, llame a la
Georgia Families 350",. Member lntake Line al
1-8ss-661-2021 (TTy 1-800-8ss-2884).
eorSr
Families
360:.
Youth Enters DFCS Custody and Enrolls in Amerigroup
Activities that occur during the first 72 hours of the youth entering DFCS custody
L' Child is removed from home, taken into DFCS custody and assigned a Social Services
Case
Manager (SSCM). The SSCM completes the following:
a. During the removal of the child and following the removal, gathers as much medical
history (through VHR, family, etc.) and enters the information into SHINES
b. Completes and sends the E Form to the Amerigroup intake unit and DCH (within 24
hours of the youth entering care)
2.
c. Submits Medicaid application via SHINES to the DFCS Rev Max unit
At the Preliminary Protective Custody hearing, a judge determines if the youth will
remain in DFCS custody. lf the judge determines the youth will remain in DFCS custody,
the social services case worker selects a CCFA provider within 24hours of the
Preliminary Protective Custody hearing; if the judge allows the child to return home, the
enrollment process stops
a. The CCFA provider confirms receipt of the referral and acceptance of the referral
3. Amerigroup receives the E Form (see step 1b) from DFCS and accesses the member's
VHR (if available) to begin care coordination planning and developing the member's
individualized care planning team; if the CCFA provider is not known at the time of form
submission, the E Form will resubmitted with including the CCFA provider referral and
noting that the E Form is an update within 24 hours of the Preliminary Protective
Custody hearing
4. Upon receiving the CCFA provider information (see step 2) from DFCS, Amerigroup will
begin coordinating medical assessments and development of individualized member
care plan
Activities that occur during the first 96 hours ofthe youth entering DFCS custody
The SSCM completes the following:
5. Updates all court orders and placement information in SHINES and sends to Rev Max Specialist
6. Sends written notification to the Amerigroup intake unit and DCH within 24 calendar hours of
the Preliminary Protective Custody hearing to notify Amerigroup Note - to finalize the use of
the E form/notifications following Preliminary Protective Custody Hearing.
The Rev Max Unit will complete the following;
7. Determines Medicaid eligibility, changes living arrangement code and removes member from
existing active/pending SUCCESS cases (within L business day of receipt of application)1.
Amerigroup will complete the following:
8. Assigns the member to a care coordination team
Activities thot occur during the first r44 hours of the youth entering DFCS custody
9. DCH receives the SUCCESS file from DFCS (see Step 7), loads the file into GAMMIS. The file
then automatically sent to Amerigroup through the daily eligibility file within 4g hours of it
is
loading into GAMMIS
Once Amerigroup receives the eligibility file from DCH, Amerigroup enrolls the member
Activities that occur within
lPossible
lr
days of the member entering DFcs custody
Categories of Assistance s: F22 or F11; Living Arrangement Code: FC; Aid Categories: 133, 131
Version 02281,4
10.
will be assigned within 2 business days and the dental home will be assigned within 5
business days of receipt of the enrollment file
11. Amerigroup will provide lD Card to members via a secure portal on the Amerigroup website
within 5 business days of receipt of eligibility file from DCH. Members may request, via phone,
that lD cards be sent via mail. lnformation packets will be provided at county DFCS offices
PCP
Version O228L4
Use Case Workflow
Acronyms
ACS
:
Assessment and Classification Specialist
AGP: Amerigroup
CCFA: Comprehensive Child and Family Assessment
CCT: Care Coordination Team
CPS
lnvestigator
:
Child Protective Services lnvestigator
DJJ: Department of Juvenile Justice
FFS: Fee for Service
ICAMA: lnterstate Compact on Adoptions and Medical Assistance
ICPC: lnterstate Compact on the Placement of Children
IFSP: lndividual Family Service plan
JPPS: Juvenile Probation Parole Specialist
MCH Assessment: Maternal and Child Health Assessment
JPPS
:
Juvenile Probation/Parole Specialist
RevMax: Revenue Maximization
RPS: Residential Placement Specialist
SSCM: SocialServices Case Manger