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Provider Manuals and Forms | Ambetter from Magnolia Health
Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2020 Provider and Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Prior Authorization Guide (PDF)
- Secure Portal (PDF)
- Payspan (PDF)
- ICD-10 Information
Medical Management
- Pre-Auth-Needed?
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Grievance and Appeals
Behavioral Health
- Discharge Consultation Form (PDF)
- Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
- Intensive Outpatient/Day Treatment Form (PDF)
- OTR Completion Tip Sheet (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)
- Taxonomy Code Billing Requirement (PDF)
- Common Claim Reject Errors (PDF)
- Electronic Transactions (EDI) (PDF)
Quality
National Imaging Associates (NIA)
