Ambetter Health provides the tools and support you need to deliver the best quality of care.

Sign up for the Ambetter of Tennessee quarterly newsletter for providers. Be the first to know about policy updates, quality incentives, and our impact in the community. Get Started.

Reference Materials

• Provider Welcome Letter (PDF)
• 2025 Provider and Billing Manual (PDF)
  
• 2024 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
  
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• Provider Orientation 2025 (PDF)
  
• Provider Orientation 2024 (PDF)
• Health Literacy and Culture (PDF)
• Telehealth and Virtual Services Guide (PDF)
• Non-Formulary And Step Therapy Exception Request Form (PDF)
• Provider Awareness Handout (PDF)
• Provider Awareness Flyer (PDF)
• Provider Rep. Territory Contact List (PDF)

Quality Improvement

• Quick Reference Guide, HEDIS® MY 2024 (PDF)
• HEDIS® Adult Pocket Guide: 2024 Measurement Year (PDF)
  
• HEDIS® Pediatric Pocket Guide: 2024 Measurement Year (PDF)
  
• Quality Improvement (QI) Program
• Centene Vision Services Eye Exam for Patients with Diabetes (EED) Tip Sheet
• Marketplace P4P Program (PDF)
• 2024 Pay for Performance (PDF)
  
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) (PDF)
• Provider CAHPS Tip Sheet (PDF)
• Supplemental Data System(SuDS) Submission Process (PDF)
• International Normalizing Ratio Monitoring for Individuals on Warfarin (INR) (PDF)
• Use of Imaging Studies for Low Back Pain (LBP) (PDF)
• Cervical Cancer Screening (CCS) (PDF)
• Chlamydia Screening in Women (CHL) (PDF)
• Controlling Blood Pressure (CBP) (PDF)
• Childhood Immunization Status (CIS) (PDF)
• Appropriate Testing for Pharyngitis (CWP) (PDF)
• Eye Exam for Patients with Diabetes (EED) (PDF)
• Immunizations for Adolescents (IMA) (PDF)
• Proportion of Days Covered: Diabetes All Class (PDC-DR) (PDF)
• Timeliness of Prenatal & Postpartum Care (PPC) (PDF)
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC) (PDF)
• Child and Adolescent Well-Care Visits (WCV) (PDF)
• Respiratory Syncytial Virus (RSV) (PDF)

Risk Adjustment

• Continuity of Care Program (PDF)
• Continuity of Care Program Appointment Agenda (PDF)
• 2024 Tiered Incentive Payments (PDF)

Medical Management

• Prior Authorization Guide
• Prior Authorization Guide (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form Continuation (PDF)
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)

Behavioral Health

• Telehealth (TeleBH) (PDF)
  
• Suicide Awareness and Education
• Optimizing the AMM, FUH, and IET HEDIS Measures Training
• Behavioral Telehealth (PDF)
• Coordination of Care Checklist (PDF)
• PCP/BH Provider Communication Form (PDF)
• Improving Patient Engagement in Behavioral Healthcare (PDF)
• Follow-Up After Hospitalization for Mental Illness (PDF)
• Discharge Planner Checklist (PDF)
• Antipsychotic and Antidepressant Medication Adherence (PDF)
• Initiation and Engagement of Substance Use Disorder Treatment (IET) (PDF)
• Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
  
• CDC’s Efforts to Prevent Overdoses and Substance Use-Related Harms

Claims and Claims Payment

• Provider Request for Reconsideration and Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)
• Consent for Sterilization Form (PDF)
  

Quality

• Practice Guidelines (PDF)
• Providing Quality Care

Other

• Centene Vision Services
• Centene Dental Services

Credentialing

For newly contracted providers, please email forms to AmbetterTNNetwork@centene.com.
For existing network providers, please email forms to AmbetterTNOps@centene.com.

• Credentialing Checklist (PDF)