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Reference Materials

• 2024 Provider & Billing Manual (PDF)
  
• 2023 Provider & Billing Manual (PDF)
• ICD-10 Information
• W-9 Fax Cover Sheet (PDF)
• Ambetter Provider Toolkit
• 2023 Provider Training (PDF)
• 2022 Provider Training (PDF)
  
• Find a Provider Guide (PDF)
• Secure Provider Portal - Eligibility Verification Guide (PDF)
• Secure Provider Portal - PCP Referral Guide (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)

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

• Claim Dispute Form (PDF)
• Billing and Coding
• No Surprises Act Open Negotiation Form (PDF)
  

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. 

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