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

• 2017 Provider & Billing Manual
• Quick Reference Guide
• Prior Authorization Guide
• Secure Portal
• Payspan
• Provider Training
• ICD-10 Information

Medical Management

• Pre-Auth Needed?
• Inpatient Prior Authorization Fax Form
• Outpatient Prior Authorization Fax Form
• Authorization and Coverage Complaints
• Durable Medical Equipment (DME) Form
• Biopharmacy Outpatient Prior Authorization Form (J-code products)

Behavioral Health

• Discharge Consultation Documentation Fax Form
• Electroconvulsive Therapy (ECT) Authorization Request Form
• Intensive Outpatient/Day Treatment Form for Mental Health/Chemical Dependency
• OTR Completion Tip Sheet
• Outpatient Treatment Request Form
• Psychological or Neuropsych Testing Authorization Request Form

Claims and Claim Payment

• Claim Dispute Form

Quality

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

Other

• Creating a Cenpatico Secure Portal Account