Manuals and Forms for Providers | Ambetter of North Carolina
Provider Resources
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2024 Provider and Billing Manual (PDF)
- 2023 Provider and Billing Manual (PDF)
- Provider Booklet (PDF)
- Payspan (PDF)
- Quick Reference Guide (PDF)
- Secure Portal (PDF)
- ICD-10 Information
- Taxonomy Reference Guide (PDF)
- Provider Portal Enhancements (PDF)
- Payspan Provider Training
- Behavioral Health Resources
- NEW for 2023: Fight Against the Flu Provider Guide (PDF)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- Ambetter of North Carolina Inc. General Flyer (PDF)
- Ambetter of North Carolina Inc. Network Flyer (PDF)
- Respiratory syncytial virus (RSV) Provider Guide (PDF)
New Provider Orientation
- Provider Orientation Presentation (PDF)
- Instructions for Attending a New Provider Orientation
- Provider Orientation 2024 Attestation of Completion
Claims and Claims Payment
- Claim Dispute Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)
- NEW: Claims and Billing Provider Guide - Upfront Rejections (PDF)
Quality Improvement
- HEDIS® Quick Reference Guide - Measurement Year 2023 (PDF)
- HEDIS® Adult Pocket Guide: 2022 Measurement Year (PDF)
- HEDIS® Pediatric Pocket Guide: 2022 Measurement Year (PDF)
- Supplemental Data System (SuDS) Submission Process (PDF)
- 2021 QUALITY RATING SYSTEM (QRS) AT-A-GLANCE (PDF)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Provider Resource Guide (PDF)
- Improve Patient Experience (PDF)
- 2024 Marketplace P4P Program (PDF)
- Provider Tip Sheets
- Appropriate Testing for Pharyngitis (CWP) (PDF)
- Cervical Cancer Screening (CCS) Tip Sheet (PDF)
- Childhood Immunizations Status (CIS) (PDF)
- Child and Adolescent Well-Care Visits (WCV) (PDF)
- Chlamydia Screening in Women (CHL) (PDF)
- Controlling Blood Pressure (CBP) (PDF)
- Eye Exam for Patients with Diabetes (EED) (PDF)
- Immunization for Adolescents (IMA) (PDF)
- International Normalizing Ratio Monitoring for Individuals on Warfarin (INR) (PDF)
- Proportion of Days Covered: Diabetes All Class (PDC-DR) (PDF)
- Timeliness of Prenatal & Postpartum Care (PPC) (PDF)
- Use of Imaging Studies for Low Back Pain (LBP) (PDF)
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC) (PDF)
Risk Adjustment
- 2024 Continuity of Care Program Guide (PDF)
- Continuity of Care Appointment Agenda (PDF)
- Continuity of Care Program Tiered Incentive Payment Chart (PDF)
Medical Management
- Prior Authorization Guide
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Prior Authorization Request Form for Non-Specialty Drugs (PDF)
- Clinical Policy: Brand Name Override and Non-Formulary Medications (PDF)