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Manuals & Forms for Providers | Ambetter from Buckeye Health Plan
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)
- Prior Auths Removed 3-31-21 (PDF)
- Secure Portal (PDF)
- Payspan (PDF)
- ICD-10 Information
- Electronic Transactions (PDF)
- Ambulatory Surgery Center Optimization Codes (PDF)
- NIA Physical Medicine Request Checklist (PDF)
- NIA Physical Medicine Services FAQs (PDF)
- NIA Expanded Partnership Provider Letter (PDF)
- National Imaging Associates, Inc. (NIA)’s Peer-to-Peer Process (PDF)
- Ambetter Prior Authorization Changes - Effective 10/01/2021 (PDF)
- Ambetter Prior Authorization Change Notification Changes Effective 11/1/21 (PDF)
- Ambetter-Step Therapy Exception Request Form Instructions & Step Therapy Exception Request Form (PDF)
- 2023 Provider Orientation (PDF)
- RSV Flyer (PDF)
- 2025 Example Member ID Card - Premier (PDF)
- 2025 Example Member ID Card - Solutions (PDF)
- Ambetter Health-Prior Authorization Form for Non-Specialty Drugs form (PDF)
- Appointment Standards for Scheduling (PDF)
- Interpreter Request Form (PDF)
- Care Management (PDF)
- 2026 Measure and Incentive Summary (PDF)
Medical Management/Behavioral Health
- Pre-Auth Needed?
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Supplemental Outpatient Prior Authorization Form (PDF)
- CDMS Barcoded Form Disclosure (PDF)
- Grievance and Appeals
- BH - Discharge Consultation Form (PDF)
- BH - SMART Goals Fact Sheet (PDF)
- Discharge Planner Checklist (PDF)
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Claims and Claim Payment
Quality
- Practice Guidelines (PDF)
- Quality Improvement (QI)
- Notification of Pregnancy Form (PDF)
- Providing Quality Care
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 Buckeye Health Plan CMS Final Rule 0057-F Prior Authorization Requirements: 41047 (PDF)
- Ambetter from Buckeye Health Plan Prior Authorization Metrics Summary: 41047 (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.