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

Reference Materials

• 2020 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 Orientation Presentation (Video)

Quality Improvement/Risk Adjustment

• HEDIS® 2020 Tip Sheet (PDF)
• HEDIS® 2020 Quick Reference Guide (PDF)
• CPT II Codes Guide (PDF)

Medical Management/ Behavioral Health

• Prior Authorization Guide (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Biopharmacy 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)

Claims and Claims Payment

• Claim Dispute Form (PDF)

Quality

• Practice Guidelines (PDF)