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Provider Resources

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

Please contact us with any questions you may have.

Reference Materials

Medical Management

Pre-Auth Needed?
Prior Authorization Guide (PDF)
Oncology Pharmacy Authorizations: For members 18 years of age or older, authorizations for oncology-related chemotherapeutic drugs and supportive agents are administered by New Century Health.
Electroconvulsive Therapy Authorization Form (PDF)
Inpatient Prior Authorization Fax Form (PDF)
Intensive Outpatient/Day Treatment Authorization Form (PDF)
Outpatient Prior Authorization Fax Form (PDF)
Outpatient Prior Authorization Supplemental Form (PDF) - This is an optional page meant to be used in conjunction with the Sunflower's Outpatient Prior Authorization Request form when a request exceeds more than four procedure codes. This page should never be submitted alone.
Outpatient Treatment Request Form (PDF)
Provider Fax Back Form (PDF)
Applied Behavioral Analysis Authorization Form (PDF)
Birth Event Notification (PDF): Optional form to report birth events/outcomes.
Neuropsychological Testing Authorization Request Form (PDF)
Transcranial Magnetic Stimulation (TMS) Request Form (PDF)
Behavioral Health Outpatient Psychological Testing Request Form (PDF)
Non-Formulary And Step Therapy Exception Request Form (PDF)
Medical Necessity Criteria
Discharge Planner Checklist (PDF)

Claims and Claims Payment

Quality

Other