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Manuals & Forms for Providers | Ambetter from NH Healthy Families
Provider Resources
Ambetter Health provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2026 Provider & Billing Manual (PDF)
- 2025 Provider & Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Pharmacy Guide (PDF)
- Claims, Disputes & Recovery/CCU Guide (PDF)
- Prior Authorization Guide (PDF)
- Secure Portal (PDF)
- Payspan (PDF)
- ICD-10 Information
- 2024 Ambetter Provider Orientation (PDF)
- CAQH Provider Data Form (PDF)
- Billing Guidelines for Newborn Babies (PDF)
- NIA Physical Medicine Program Provider Training (PDF)
- Provider Change Form (PDF)
- Step Therapy Exception Request Form (PDF)
- Notification of Pregnancy (NOP) Report (PDF)
- Interpreter Request Form (PDF)
- Interpreter Services FAQ for Providers (PDF)
- Care Management (PDF)
Medical Management/Behavioral Health
- Pre-Auth Needed?
- Inpatient Authorization Form (PDF)
- Outpatient Authorization Form (PDF)
- Non-OB Ultrasound Authorization Form (PDF)
- Discharge Consultation From (PDF)
- Discharge Planner Checklist (PDF)
- Behavioral Health Provider Specialty Profile (PDF)
- Prescription Fulfillment (PDF)
- Coordination of Care (PDF)
- Collaboration of Care: Medication Management (PDF)
- Transition Planning (PDF)
- Caregiver Training (PDF)
- Functional Behavior Assessments and Behavior Intervention Plans (PDF)
- Applied Behavioral Analysis Prior Authorization Request Form (PDF)
- Notification of Pregnancy (NOP) (PDF)
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Claims & Claims Payment
- Claim Dispute Form (PDF)
- Explanation of Payment Request (PDF)
- CAH Billing Tip Sheet (PDF)
- Negative Balance Tip Sheet (PDF)
- Provider Negative Balance Request Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)
Quality
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 NH Healthy Families CMS Final Rule 0057-F Prior Authorization Requirements: 75841 (PDF)
- Ambetter from NH Healthy Families Prior Authorization Metrics Summary: 75841 (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.