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Provider Resources, Manuals & Forms | Ambetter from Sunshine Health
Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Training
Reference Materials
- 2020 Provider and Billing Manual (PDF)
- 2021 Provider and Billing Manual (PDF)
- Quick Reference Guide (PDF)
- ICD-10 Information
- Payspan (PDF)
- Secure Portal (PDF)
- Secure Provider Website Registration (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)
- Notification of Pregnancy Form (PDF)
- Risk Adjustment Coding Guidelines
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
Quality
- HEDIS Quick Reference Guide 2020 (PDF)
- Quality Improvement (QI)
- Practice Guidelines (PDF)
- Appropriate Treatment for Upper Respiratory Infection (URI) (PDF)
- Appropriate Testing for Pharyngitis (CWP) (PDF)
- Use of Imaging Studies for Low Back Pain (PDF)
- Best Practices for Prescribing Opioids (PDF)