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Materiales de referencia

• 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)

Administración médica

• Pre-Auth Needed?
• Outpatient Prior Authorization Fax Form (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Authorization and Coverage Complaints
• Biopharmacy Outpatient Prior Authorization Form (J-code products) (PDF)
• House Bill 3459 Preauthorization Exemption Program (PDF)

Salud del comportamiento

• Discharge Consultation Documentation Fax Form (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Formulario de solicitud de cambio de proveedor (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)
  

Reclamaciones y pago de reclamaciones

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

Calidad

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)