Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2018 Provider & Billing Manual (PDF)\
- 2019 Provider & 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
- Place of Service Codes 2014 (PDF)
- Maximum Units of Service 2014 (PDF)
- Modifer 25 – 2014 (PDF)
Behavioral Health
- Discharge Consultation Form
- Electroconvulsive Therapy (ECT) Authorization Request Form
- Intensive Outpatient/Day Treatment Form
- OTR Completion Tip Sheet
- Outpatient Treatment Request Form
- Psychological or Neuropsych Testing Authorization Request Form
- SMART Goals Fact Sheet
Claims and Claim Payment
- Claim Dispute Form
- Taxonomy Code Billing Requirement (PDF)
- Common Claim Reject Errors (PDF)
- Electronic Transactions (EDI)
- CMS FQHC-RHC Billing Guide 2014 (PDF)
- CMS 1500 Claim Form Instructions 2014 (PDF)
- Obstetrical Care Billing Tips 2014 (PDF)
Quality
- Clinical Practice Guidelines
- 2016 HEDIS Quick Reference Guide
- CDC Immunization Schedule (Ages 0-6) 2014 (PDF)
- CDC Immunization Schedule (Ages 7-18) 2014 (PDF)
- CDC Immunization Schedule (Ages 19+) 2014 (PDF)
- Quality Improvement (QI)