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Manuals & Forms for Providers | Ambetter from Sunflower Health Plan
Provider Resources
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
- 2023 Provider and Billing Manual (PDF)
- 2022 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)
- Ambetter Virtual Access Referral Guide
- Ambetter Virtual Access Training (PDF)
- Ambetter Virtual Access Training Presentation
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)
- Transcranial Magnetic Stimulation (TMS) Request Form (PDF)
Claims and Claims Payment
- Provider Request for Reconsideration and Claim Dispute Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)