Provider Resources, Manuals, and Forms | Ambetter from Superior HealthPlan
Provider Resources
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.
Ambetter provides the tools and support you need to deliver the best quality of care.
Click here to view our schedule of upcoming Provider trainings.
Reference Materials
- 2024 Provider & Billing Manual (PDF)
- 2023 Provider & Billing Manual (PDF)
- ICD-10 Information
- W-9 Fax Cover Sheet (PDF)
- Ambetter Provider Toolkit
- 2024 Provider Training (PDF)
- 2023 Provider Training (PDF)
- Find a Provider Guide (PDF)
- Quick Reference Guide: How to Identify an In-Network Provider (PDF)
- Secure Provider Portal - Quick reference Guide: How to Verify Eligibility (PDF)
- Secure Provider Portal - How to Make PCP Referral for Value and Virtual Plans (PDF)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
Medical Management
- Pre-Auth Needed?
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Grievance and Appeals
- Biopharmacy Outpatient Prior Authorization Form (J-code products) (PDF)
- House Bill 3459 Preauthorization Exemption Program (PDF)
- Specialist as PCP Request Form (PDF)
Behavioral Health
- Discharge Consultation Documentation Fax Form (PDF)
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Change of Provider Request Form (PDF)
- Transcranial Magnetic Stimulation Services Prior Authorization Checklist (PDF)
- Psychological and Neuropsychological Testing Checklist (PDF)
- Electroconvulsive Therapy (ECT) Checklist (PDF)
- Ambetter Behavioral Health Billing Clinic (PDF)
High Tech Imaging
Ambetter from Superior HealthPlan has selected National Imaging Associates, Inc. (NIA) to provide radiology network management services. NIA manages the prior authorizations for non-emergent, advanced, outpatient imaging services rendered to Ambetter members.
- NIA: High Tech Imaging QRG for Rendering Facilities (PDF)
- NIA: High Tech Imaging QRG for Ordering Physicians (PDF)
Claims and Claim Payment
Quality
Maintaining accreditation is Ambetter’s long-standing commitment to provide quality health-care service and programs to your patients. The goal of our Quality Improvement Program is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings. Learn more about our Quality Improvement activities.