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

Call Provider Services For Help

If you need help, call Provider Services at 1-877-687-1169 (Relay Florida 1-800-955-8770) Monday through Friday from 8 a.m. to 8 p.m. Eastern. Stay up to date on Ambetter from Sunshine Health provider notices by reviewing and bookmarking Provider News.

Provider Toolkit

We believe that delivering quality care doesn’t have to be complicated. So, to make working with us easier, we developed the Ambetter Provider Toolkit. It’s designed to provide you with valuable education and materials to simplify your administrative responsibilities—so you can focus on providing care.

• Provider Quick Reference Guide
• Prior Authorization Guide
• Electronic Funds Transfer (EFT) Features
• Secure Web Portal Features
• Ambetter Plan Offerings
• FAQs

Provider Forms

Training

• Ambetter Provider Orientation Training webinars

Reference Materials

• 2025 Provider and Billing Manual (PDF)
  
• 2024 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• Pharmacy Guide (PDF)
• Claims, Disputes & Recovery/CCU Guide (PDF)
• Appeals/Reconsiderations (Medical) And Grievances Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• Telemedicine
• Referral and Authorization Information

Medical Management

• Pre-Auth Needed?
• Prior Authorization Guide (PDF)
• Inpatient Prior Authorization Form (PDF)
• Outpatient Prior Authorization Form (PDF)
• Outpatient Prior Authorization Requirements (PDF)
• Grievance and Appeals
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)
• Prior Authorization Request Form for Specialty Medication (PDF)
• Notification of Pregnancy Form (PDF)
• Risk Adjustment Coding Guidelines
• Non-Formulary And Step Therapy Exception Request Form (PDF)
• Supplemental Outpatient Authorization Form (PDF)

Behavioral Health

• Discharge Consultation Form (PDF)
• Discharge Planner Checklist (PDF)
• SMART Goals Fact Sheet (PDF)
• OTR Tip Sheet (PDF)
• Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)

Claims and Claims Payment

• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)

Standards for Appointment Scheduling

• Ambetter Provider Standards for Appointment Scheduling

Quality

• Quality Improvement (QI)
• Child and Adolescent Well Care Visits (WCV) (PDF)
  
• Practice Guidelines (PDF)
• Appropriate Treatment for Upper Respiratory Infection (URI) (PDF)
• Appropriate Testing for Pharyngitis (CWP) (PDF)
• Use of Imaging Studies for Low Back Pain (PDF)
• Pediatric HEDIS Measures (PDF)
• Providing Quality Care

Emergency Room Alternatives

• Ambetter Health Getting Care Quickly (PDF)

Fraud, Waste, and Abuse

• Referral Form Fraud, Waste, and Abuse (PDF)

Other

• Centene Vision Services
• Centene Dental Services