NEED HEALTH INSURANCE? SHOP OUR PLANS.
Provider Resources
Provider Resources
Ambetter Health provides the tools and support you need to deliver the best quality of care.
Sign up for the Ambetter of Alabama quarterly newsletter for providers. Be the first to know about policy updates, quality incentives, and our impact in the community. Get Started.
Reference Materials
- Provider Welcome Letter (PDF)
- 2025 Provider and Billing Manual (PDF)
- 2024 Provider and Billing Manual (PDF)
- 2025 Provider Orientation (PDF)
- 2024 Provider Orientation (PDF)
- Quick Reference Guide (PDF)
- Pharmacy Guide (PDF)
- Claims, Disputes & Recovery/CCU Guide (PDF)
- Appeals/Reconsiderations (Medical) And Grievances Guide (PDF)
- Simplify Office Administrative Tasks Quick Reference Guide (PDF)
- ICD-10 Information
- Payspan
- Payspan Quick Guide (PDF)
- Secure Portal
- Secure Portal Quick Guide (PDF)
- No Surprises Act
- Respiratory Syncytial Virus (RSV) Provider Guide (PDF)
- Annual Preventative Visit Flyer (PDF)
Medical Management
- Prior Authorization
- Prior Authorization Quick Guide (PDF)
- Inpatient Authorization Form (PDF)
- Outpatient Authorization Form (PDF)
- Outpatient Prior Authorization Fax Form Continuation (PDF)
- Prior Authorization Request Form for Non-Specialty Drugs (PDF)
- Musculoskeletal (MSK) Management Program Update (PDF)
- Concurrent Review (CCR) (PDF)
Behavioral Health
- Suicide Awareness and Education
- CDC'c Efforts to Prevent Overdoses and Substance Use-Related Harms
- Antipsychotic and Antidepressant Medication Adherence (PDF)
- CAHPS® Experience of Care and Outcomes (ECHO) Survey (PDF)
- Coordination of Care Checklist (PDF)
- Discharge Planner Checklist (PDF)
- Improving Patient Engagement in Behavioral Healthcare (PDF)
- Primary Care Provider (PCP)/Behavioral Health (BH) Provider Communication Form (PDF)
- Psychiatric Collaborative Care Model (PDF)
- Reducing the Stigma Surrounding Mental Illness (PDF)
- Telehealth for Behavioral Health Care (PDF)
- The Importance of Depression Screenings (PDF)
- The Importance of Follow-up Care for Mental Illness (PDF)
- 2024 Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
- 2025 Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Quality Improvement
- Providing Quality Care
- Improve Patient Experience and Quality of Care (PDF)
- Supplemental Data System (SUDS) Submission Process (PDF)
- Consumer Assessment Of Healthcare Providers And Systems (CAHPS®) (PDF)
- Quick Reference Guide HEDIS® (PDF)
- HEDIS® Adult Pocket Guide: 2025 Measurement Year (PDF)
- HEDIS® Pediatric Pocket Guide: 2025 Measurement Year (PDF)
- Centene Vision Eye Exam for Patients w/ Diabetes Tip Sheet
- Provider CAHPS Tip Sheet (PDF)
- Childhood Immunization Status (CIS) (PDF)
- Cervical Cancer Screenings Tip Sheet (PDF)
- Chlamydia Screening in Women (CHL) (PDF)
- Controlling Blood Pressure (CBP) (PDF)
- International Normalizing Ratio Monitoring For Individuals On Warfarin Tip Sheet (PDF)
- Use Of Imaging Studies For Low Back Pain (PDF)
- Appropriate Testing For Pharyngitis (CWP) (PDF)
- Immunizations For Adolescents (IMA) (PDF)
- Eye Exam For Patients With Diabetes (EED) (PDF)
- Timeliness Of Prenatal & Postpartum Care (PPC) (PDF)
- Weight Assessment And Counseling For Nutrition And Physical Activity For Children And Adolescents (WCC) (PDF)
- Proportion Of Days Covered: Diabetes All Class (PDC-DR) (PDF)
- Marketplace Pay-for-Performance (P4P) Program (PDF)
- Respiratory syncytial virus (RSV) (PDF)
- Child And Adolescent Well-Care Visits (WCV) (PDF)
- Telehealth (TeleBH) Behavioral Health Care (PDF)
- Initiation and Engagement of Substance Use Disorder Treatment (PDF)
- Optimizing the Impact of the Behavioral Health AMM, FUH, and IET HEDIS® Measures (PDF)
Forms
Claims and Claims Payment
- Provider Request for Reconsideration and Claim Dispute Form (PDF)
- Consent for Sterilization Form (PDF)
- Process for Readmission Within 30 Days (PDF)