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Provider Manuals & Forms | Ambetter from Nebraska Total Care
Provider Resources
Ambetter Health provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2026 Provider and Billing Manual (PDF)
- 2025 Provider and Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Pharmacy Guide (PDF)
- Claims, Disputes & Recovery/CCU Guide (PDF)
- Well-Being Survey (PDF)
- Member Notification of Pregnancy (PDF)
- Member Notification of Pregnancy - Spanish (PDF)
- Notification of Pregnancy Form (PDF)
- Known Issues and Resolution Timeframes
- No Surprises Act Open Negotiation Form (PDF)
- Claim Dispute Form (PDF)
- Providing Quality Care
- Step Therapy Exception Request Form (PDF)
- Appointment Standards for Scheduling (PDF)
- Interpreter Request Form (PDF)
- Prior Authorization Prescription Drug Benefits / DME (PDF)
- Prior Authorization Form Healthcare Services / Medical Injectables (PDF)
- Care Management (PDF)
- 2026 HEDIS Quick Reference Guide (PDF)
Evolent Documents
- Evolent Frequently Asked Questions (FAQ’s) Prior Authorization Program Physical Medicine Services (PDF)
- Physical Medicine Program Provider Training (PDF)
- Physical Medicine Prior Authorization Quick Reference Guide for Providers (PDF)
- Physical Medicine Request Tip Sheet/Checklist (PDF)
- RadMD Access for Physical Medicine Providers to Request Prior Authorization (PDF)
- RadMD Quick Start Guide Physical Medicine Authorization Requests (PDF)
ABA Tip Sheets
- Caregiver Training (PDF)
- Coordination of Care (PDF)
- Functional Behavior Assessments and Behavior Intervention Plans (PDF)
- Medication Management (PDF)
- Prescription Fulfillment (PDF)
- Transition Planning (PDF)
Behavioral Health
- Co-Occurring Disorders Screening, Diagnosis, and Treatment
- Supporting Patients with Alcohol Use Disorder: Current Approaches to Management and Treatment
- Recovery Support Tools and Resources
- Peer Support Services in Crisis Care (PDF)
- Coordination of Care Checklist (PDF)
- Improving Patient Engagement in Behavioral Healthcare (PDF)
- Primary Care Provider/Behavioral Health Provider Communication Form (PDF)
- Telehealth for Behavioral Health Care (PDF)
- Outpatient OTR Tip Sheet 2023 (PDF)
- Discharge Planner Checklist (PDF)
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Other
CMS Interoperability & Prior Authorization Final Rule: CY2025 Prior Authorization Requirements Reports and Metrics Summaries
In accordance with the Centers for Medicare & Medicaid Services (CMS) Final Rule (CMS 0057 F), we are annually publishing our prior authorization requirements and performance metrics to promote transparency, accountability, and better support our members and providers.
Reports:
- Ambetter from Nebraska Total Care CMS Final Rule 0057-F Prior Authorization Requirements: 26289 (PDF)
- Ambetter from Nebraska Total Care Prior Authorization Metrics Summary: 26289 (PDF)
The data presented in these publications reflects prior authorization requests processed during the applicable measurement year in accordance with CMS reporting specifications. Metrics are calculated using CMS defined methodologies and may not be directly comparable to alternative reports or third party summaries.