Provider Resources

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

Reference Materials

• 2017 Provider and Billing Manual
• Quick Reference Guide
• ICD-10 Information
• Payspan
• Secure Portal

Medical Management

• Pre-Auth Needed?
• Prior Authorization Guide
• Inpatient Prior Authorization Fax Form
• Outpatient Prior Authorization Fax Form
• Authorization and Coverage Complaints
• Prior Authorization Request Form for Non-Specialty Drugs
• Prior Authorization Request Form for Specialty Medication

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 Claims Payment

• Claim Dispute Form

Quality

• 2016 HEDIS Quick Reference Guide
• Quality Improvement (QI)
• Clinical Practice Guidelines

Other

• Creating a Cenpatico Secure Portal Account