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

• 2018 Provider & Billing Manual (PDF)
• Quick Reference Guide (PDF)
• Prior Authorization Guide (PDF)
• Secure Portal (PDF)
• Payspan (PDF)
• Provider Training (PDF)
• ICD-10 Information

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)

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)
• Intensive Outpatient Treatment Form (PDF)
• Psychological or Neuropsych Testing Inpatient Authorization Request Form (PDF)
• OTR Completion Tip Sheet (PDF)

Claims and Claim Payment

• Claim Dispute Form (PDF)

Quality

• Clinical Practice Guidelines
• 2016 HEDIS Quick Reference Guide (PDF)
• Quality Improvement (QI)

Other

• Creating a Cenpatico Secure Portal Account (PDF)