Ambetter provides the tools and support you need to deliver the best quality of care.

Reference Materials

• 2019 Provider and Billing Manual (PDF)
• Provider Manual Addendum (PDF)
• Prior Authorization Guide (PDF)
• Payspan (PDF)
• Quick Reference Guide (PDF)
• Secure Portal (PDF)
• Provider Expedited Certification (PDF)
• Appeal Request Form (PDF)

Medical Management

• Pre-Auth needed?
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)
• Prior Authorization Request Forms for Specialty Drugs
• Grievance and Appeals

Claims and Claims Payment

• Provider Request for Reconsideration and Claim Dispute Form (PDF)

Quality

• Clinical Practice Guidelines (PDF)