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Manuals & Forms for Providers | Ambetter from MHS Indiana
Provider Resources
Coronavirus (COVID-19)
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2020 Provider and Billing Manual (PDF)
- 2021 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)