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Provider Resources
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)
- No Surprises Act Open Negotiation Form (PDF)
- Providing Quality Care
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- Discharge Planner Checklist (PDF)
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
- Appointment Standards for Scheduling (PDF)
- Interpreter Request Form (PDF)
Forms
- Inpatient Authorization Form (PDF)
- Outpatient Authorization Form (PDF)
- Notification of Pregnancy Form (PDF)
- Claim Dispute Form (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 of Oklahoma CMS Final Rule 0057-F Prior Authorization Requirements: 62505 (PDF)
- Ambetter of Oklahoma Prior Authorization Metrics Summary: 62505 (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.
Provider Trainings
Register for an Ambetter of Oklahoma New Provider Orientation:
There are not any webinars scheduled at this time.
There are not any webinars scheduled at this time, but please visit NIA’s website (RadMD) for lots of helpful resources such as Tips Sheets, Quick Reference Guides, FAQs, and training presentations.