Materiales de referencia

• 2023 Provider and Billing Manual (PDF)
  
• 2022 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• Payspan (PDF)
• Secure Portal (PDF)
• ICD-10 Information
• Wellness and Preventive Services Fact Sheet (PDF)
• Provider Portal Initiative FAQ (PDF)
• Envolve Vision Plan Specifics (PDF)
• Ambetter Reimburses for Substance Use Services (PDF)
  
• Long-Acting Medications as First-Line Treatment in Schizophrenia (PDF)
• Provider Data Change Form (PDF)

Administración médica/Salud del comportamiento

• Pre-Auth Needed?
• Prior Authorization Guide (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Authorization and Coverage Complaints
• Discharge Consultation Form (PDF)

Reclamaciones y pago de reclamaciones

• Electronic Transactions (PDF)
• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)

Calidad

• Practice Guidelines (PDF)
• Plan de Competencia cultural (PDF)
• Quality Improvement (QI)
• Ambetter Member Reassignment Form (PDF)

Provider Credentialing

• Allied and Advance Practice Nurse Credentialing Application (PDF)
• Medical Doctor or Doctor of Osteopathy Credentialing Application (PDF)

To see all coding tip sheets, please visit Coding Tip Sheets And Forms.

Ambetter Prior Authorization Statistics