Training

• Ambetter Provider Orientation Training webinars

Reference Materials

• 2022 Provider and Billing Manual (PDF)
  
• 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 Form (PDF)
• Outpatient Prior Authorization 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

• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)

Quality

• HEDIS Quick Reference Guide 2020 (PDF)
• Quality Improvement (QI)
• Child and Adolescent Well Care Visits (WCV) (PDF)
  
• 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)

Fraud, Waste, and Abuse

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