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Manuals & Forms for Providers | Ambetter from Sunflower Health Plan
Provider Resources
Coronavirus (COVID-19)
Ambetter provides the tools and support you need to deliver the best quality of care.
Please contact us with any questions you may have.
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)
- Provider Resource Guide (PDF)
- Outpatient Psychological Testing Authorization Request Form (PDF)
- Ambetter Claim Reconsideration and Appeal Quick Reference Guide (PDF)
Medical Management
- Pre-Auth Needed?
- Prior Authorization Guide (PDF)
- Oncology Pharmacy Authorizations: For members 18 years of age or older, authorizations for oncology-related chemotherapeutic drugs and supportive agents are administered by New Century Health.
- Electroconvulsive Therapy Authorization Form (PDF)
- Inpatient Prior Authorization Fax Form (PDF)
- Intensive Outpatient/Day Treatment Authorization Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Outpatient Treatment Request Form (PDF)
- Provider Fax Back Form (PDF)
- Applied Behavioral Analysis Authorization Form (PDF)
- Birth Event Notification (PDF): Optional form to report birth events/outcomes.
- Neuropsychological Testing Authorization Request Form (PDF)
Claims and Claims Payment
- Provider Request for Reconsideration and Claim Dispute Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)