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

Reference Materials

• 2020 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• Provider Resource 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)
• Psychological or Neuropsych Testing Authorization Form (PDF)
• Provider Fax Back Form (PDF)
• Applied Behavioral Analysis Authorization Form (PDF)

Claims and Claims Payment

• Claim Dispute Form (PDF)

Quality

• Quality Improvement (QI)
• Clinical Practice Guidelines

Other

• Ambetter Payment Policy Manual
• Provider/Practioner Changes
• Trainings