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HAVE AN ENROLLMENT NEED? SHOP OUR PLANS
Main Menu
-
Our Health Plans
show Our Health Plans menu
-
- About Our Plans
- Our Benefits
- My Health Pays Rewards®
- Coverage Area Map
- Ways to Save
- What is Ambetter Health?
- Shop and Compare Plans
- Find a Doctor
Use your ZIP Code to find your personal plan.
- See coverage in your area
- Find doctors and hospitals
- View pharmacy program benefits
- View essential health benefits
Find and enroll in a plan that's right for you.
-
-
Join Ambetter Health
show Join Ambetter Health menu
-
- Four easy steps is all it takes
- What you need to enroll
- Special Enrollment Information
-
-
For Members
show For Members menu
-
- Pay Now
- Find a Doctor
- Drug Coverage
- Forms and Materials
- Ways to Pay
- New Members
- Renew Your Plan
- Better Health Center
- The Better Bulletin
- Member News
- Health Savings Account
Find everything you need in the member online account
- View your claims
- Review your plan benefits
- Print your ID card
- View rewards points total
-
Manuals and Forms for Providers | Ambetter of North Carolina
Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2023 Provider and Billing Manual (PDF)
- 2022 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 (PDF)
- Provider Portal Enhancements (PDF)
- Payspan Provider Training
- Behavioral Health Resources
- NEW for 2023: Fight Against the Flu Provider Guide (PDF)
Quality Improvement
- HEDIS® MY 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)
- 2023 Marketplace P4P Program (PDF)
- Chlamydia Screening in Women (CHL) - Provider Tip Sheet (PDF)
Risk Adjustment
- Continuity of Care Training (PDF)
- Continuity of Care Program Booklet (PDF)
- Specialist Continuity of Care Program (PDF)
- Continunity 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)