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

Reference Materials

• 2019 Provider and Billing Manual (PDF)
• 2020 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)

Medical Management

• Pre-Auth Needed?
• Prior Authorization Guide (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Grievance and Appeals
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)
• Prior Authorization Request Form for Specialty Medication (PDF)

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)

Claims and Claims Payment

• Claim Dispute Form (PDF)

Quality

• HEDIS Quick Reference Guide (PDF)
• Quality Improvement (QI)
• Clinical Practice Guidelines

Fraud, Waste, and Abuse

• Referral Form Fraud, Waste, and Abuse (PDF)