Ambetter provides the tools and support you need to deliver the best quality of care.

Reference Materials

• 2020 Provider and Billing Manual (PDF)
• ICD-10 Information
• Quick Reference Guide (PDF)
• Prior Authorization Guide (PDF)
• Payspan (PDF)
• Secure Portal (PDF)
• Provider Newsletters
• Provider Network Guide (PDF)
• Home Health Filing Guidelines (PDF)

Medical Management

• Pre-Auth Needed?
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Fillable Prior Authorization Form (PDF)
• Grievance and Appeals
• Clinical Practice and Preventive Health Guidelines (PDF)
• Outpatient to ASC Prior Authorization by County (PDF)

Behavioral Health

• OTR Completion Tip Sheet (PDF)
• Discharge Consultation Form (PDF)
• Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
• Intensive Outpatient/Day Treatment Form for Mental Health/Chemical Dependency (PDF)
• Outpatient Treatment Request Form (PDF)
• Psychological or Neuropsych Testing Authorization Request Form (PDF)
• SMART Goals Fact Sheet (PDF)
• Applied Behavioral Analysis Prior Authorization Request Form (PDF)

Claims and Claim Payment

• Claim Dispute Form (PDF)

Quality

• Practices Guidelines (PDF)
• 2016 HEDIS Quick Reference Guide (PDF)
• Quality Improvement (QI)

Other

• Provider Updates
• Opioid Prescribing Limits (PDF)