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

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)

Quality

• Quality Improvement (QI)
• Practice Guidelines (PDF)

Other

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