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Provider Resources, Manuals, and Forms | Ambetter from Superior HealthPlan
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
- 2023 Provider & Billing Manual (PDF)
- 2022 Provider & Billing Manual (PDF)
- 2021 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)
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)
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.