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

Click here to view our schedule of upcoming Provider trainings.

Reference Materials

• 2025 Provider & Billing Manual (PDF)
  
• 2024 Provider & Billing Manual (PDF)
• ICD-10 Information
• W-9 Fax Cover Sheet (PDF)
• Ambetter Provider Toolkit
• 2024 Provider Training (PDF)
  
• 2023 Provider Training (PDF)
• Find a Provider Guide (PDF)
• Quick Reference Guide: How to Identify an In-Network Provider (PDF)
• Secure Provider Portal - Quick reference Guide: How to Verify Eligibility (PDF)
• Secure Provider Portal - How to Make PCP Referral for Value and Virtual Plans (PDF)
• Non-Formulary And Step Therapy Exception Request Form (PDF)
• INR Monitoring for Individuals on Warfarin (PDF)

Medical Management

• Pre-Auth Needed?
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Grievance and Appeals
• Biopharmacy Outpatient Prior Authorization Form (J-code products) (PDF)
• House Bill 3459 Preauthorization Exemption Program (PDF)
• Specialist as PCP Request Form (PDF)

Behavioral Health

• Discharge Consultation Documentation Fax Form (PDF)
• Discharge Planner Checklist (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Change of Provider Request Form (PDF)
• Transcranial Magnetic Stimulation Services Prior Authorization Checklist (PDF)
• Psychological and Neuropsychological Testing Checklist (PDF)
• Electroconvulsive Therapy (ECT) Checklist (PDF)
  
• Ambetter Health Behavioral Health Billing Clinic (PDF)

High Tech Imaging

Ambetter from Superior HealthPlan has selected National Imaging Associates, Inc. (NIA) to provide radiology network management services. NIA manages the prior authorizations for non-emergent, advanced, outpatient imaging services rendered to Ambetter members. 

• NIA: High Tech Imaging QRG for Rendering Facilities (PDF)
• NIA: High Tech Imaging QRG for Ordering Physicians (PDF)

Claims and Claim Payment

• Claim Dispute Form (PDF)
• Billing and Coding
• No Surprises Act Open Negotiation Form (PDF)
  
• FQHC Quick Reference Guide (PDF)

Quality

Maintaining accreditation is Ambetter’s long-standing commitment to provide quality health-care service and programs to your patients. The goal of our Quality Improvement Program is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings. Learn more about our Quality Improvement activities. 

• Practice Guidelines (PDF)
• Quality Improvement (QI)

Other

• Centene Vision Services
• Centene Dental Services