Member Resources

Many of our member resources can be found by logging into your online member account. Click Login to create an account and access a wide array of resources!

Quick Reference Guide (QRG)

Reference Materials

Forms

Inform Ambetter of a Balance Bill

Revocation of Authorization to Disclose Health Information Form (PDF)

MAXIMUS Appointment of Representative Form (PDF)

MAXIMUS External Review Request Information Form (PDF)

Dental Reimbursement Form (PDF)

Member Transplant Travel Reimbursement Policy - English (PDF)

Authorization Representative Designation Form (PDF)

Out-of-pocket Expense Credit Instructions (PDF)

Please check our Ambetter Guide for the most current provider listings. To request a current non-electronic (paper) listing of all Ambetter in-network providers at no cost, please contact Ambetter Member Services through the Online Member Portal, by email at SHPMSCONTACTUS@CENTENE.COM or by calling 1-877-687-1196 (Relay Texas/TTY 1-800-735-2989) from 8 a.m. to 8 p.m. CT, Monday through Friday.

Member Materials and Forms | Ambetter from Superior HealthPlan

Member Resources

Quick Reference Guide (QRG)

Reference Materials

Forms

Inform Ambetter of a Balance Bill

Authorization to Disclose Health Information Form (Electronic)

Revocation of Authorization to Disclose Health Information Form

Complaint Form

MAXIMUS Appointment of Representative Form

MAXIMUS External Review Request Information Form

Dental Reimbursement Form

Prescription Claim Reimbursement Form

Donor Transplant Travel Reimbursement Form

Recipient Transplant Travel Reimbursement Form

Member Transplant Travel Reimbursement Policy

Authorization Representative Designation Form

Member Reimbursement Medical Claim Form

Out-of-pocket Expense Credit Instructions