Reference Materials

• 2022 Provider and Billing Manual (PDF)
  
• 2020 Provider and Billing Manual (PDF)
• 2021 Provider and Billing Manual (PDF)
  
• Quick Reference Guide (PDF)
• Prior Authorization Guide (PDF)
• Secure Portal (PDF)
• Payspan (PDF)
• ICD-10 Information
• Ambetter Provider Tip Sheet (PDF)
  
• Adult Wellness Visit Checklist (PDF)
  

Medical Management

• Pre-Auth-Needed?
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Grievance and Appeals
• Birth Event Notification
  

Population Health/Behavioral Health

• Discharge Consultation Form (PDF)
• SMART Goals Fact Sheet (PDF)

Claims and Claim Payment

• Claim Dispute Form (PDF)
• Taxonomy Code Billing Requirement (PDF)
• Common Claim Reject Errors (PDF)
• Electronic Transactions (EDI) (PDF)
• No Surprises Act Open Negotiation Form (PDF)

Quality

• Practice Guidelines (PDF)
• Quality Improvement (QI)

National Imaging Associates (NIA)

• NIA Transthoracic Echocardiography Announcement (PDF)
• Transthoracic Echocardiography (TTE) Guidelines (PDF)
• NIA FAQ (PDF)