Provider Resources

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

2020 Provider & Billing Manual (PDF)
Quick Reference Guide (PDF)
Prior Authorization Guide (PDF)
Secure Portal (PDF)
Payspan (PDF)
Provider Training (PDF)
ICD-10 Information
W-9 Fax Cover Sheet (PDF)
Ambetter Provider Toolkit (PDF)

Medical Management

Pre-Auth Needed?
2020 Inpatient Prior Authorization Fax Form (PDF)
2020 Outpatient Prior Authorization Fax Form (PDF)
LTSS and Pharmacy Inpatient Prior Authorization Fax Form (PDF)
LTSS and Pharmacy Outpatient Prior Authorization Fax Form (PDF)
Grievance and Appeals
Biopharmacy Outpatient Prior Authorization Form (J-code products) (PDF)

Behavioral Health

Discharge Consultation Documentation Fax Form (PDF)
Inpatient Electroconvulsive Therapy (ECT) Request Form (PDF)
Outpatient Electroconvulsive Therapy (ECT) Request Form (PDF)
Outpatient Treatment Request Form (PDF)
Psychological or Neuropsych Testing Inpatient Authorization Request Form (PDF)
OTR Completion Tip Sheet (PDF)
2020 Inpatient Prior Authorization Fax Form (PDF)
2020 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)

Pharmacy Resources

Antidepressant Medication Management (AMM) (PDF)
Medication Management for People with Asthma (MMA) (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.