Click here to view our schedule of upcoming Provider trainings.

Reference Materials

• 2020 Provider & Billing Manual (PDF)
• 2021 Provider & Billing Manual (PDF)
• ICD-10 Information
• W-9 Fax Cover Sheet (PDF)
• Ambetter Provider Toolkit
• Provider Training (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. 

• 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

Quality

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