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Renew by Dec. 15 for Jan. 1 coverage. Stay covered with Ambetter Health.

Renew by Dec. 15 for Jan. 1 coverage. Stay covered with Ambetter Health.

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Ambetter Outpatient Authorization Form

Date: 03/22/24

Ambetter from Nebraska Total Care has improved the Outpatient Prior Authorization Form to include a dedicated fax line for Buy and Bill Drugs. The revised form will become effective 04/01/2024.

Ambetter Prior Authorization Forms can be downloaded from the Ambetter Provider Resources page.