Quick Reference Links for Authorization Requirements and Guidelines

All Clinical policies (criteria) should be reviewed prior to initiating any procedure that does not require prior authorization.

Authorization Requirement and Payment Policy Guidelines

• Clinical and Payment Policies
• Prior Authorization Tool
• Machine-Readable Prior Authorization List (updated quarterly)
• InterQual Guidelines

Authorization Submission Locations

• Turning Point
• Evolent
• Availity Portal / Ambetter Provider Portal

For the latest announcements, refer to the provider news page. 

Materiales de referencia

• 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)
• Payspan (PDF)
• Secure Portal (PDF)
• ICD-10 Information
• Wellness and Preventive Services Fact Sheet (PDF)
• Provider Portal Initiative FAQ (PDF)
• Ambetter Reimburses for Substance Use Services (PDF)
  
• Long-Acting Medications as First-Line Treatment in Schizophrenia (PDF)
• Provider Data Change Form (PDF)
• Step Therapy Exception Request Form (PDF)
• Opioid Resources for Prescribers
• Adult Immunization (PDF)
• METS (Members Empowered to Succeed) (PDF)
• METS Frequently Asked Questions (PDF)
• Remittance Advice/Explanationof Payment (EOP) Guide (PDF)
• Sober Sidekick - Transforming Recovery and Enhancing Care (PDF)
• Intro to Sober Sidekick Provider Training (PDF)
• Sober Sidekick Frequently Asked Questions (PDF)
• Arkansas Roster Template (CSV)

Administración médica/Salud del comportamiento

• Pre-Auth Needed?
• Prior Authorization Guide (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Supplemental Outpatient Prior Authorization Form (PDF)
• Authorization and Coverage Complaints
• Discharge Consultation Form (PDF)
• Discharge Planner Checklist (PDF)
• Turning Point Prior Authorization
• Benefit Inquiry Form (PDF)
• Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)

Reclamaciones y pago de reclamaciones

• Electronic Transactions (PDF)
• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)

Calidad

• Practice Guidelines (PDF)
• Plan de Competencia cultural (PDF)
• Quality Improvement (QI)
• Ambetter Member Reassignment Form (PDF)
• Providing Quality Care
• Diabetic Care Coordination (PDF)
• Well Woman Visit Coding Tips (PDF)

Material educativo

• Plan All-Cause Readmission (PCR) (PDF)
• Social Needs Screeningand Intervention (SNS-E): Transportation (PDF)
• Social Needs Screening andIntervention (SNS-E): Housing (PDF)
• Social Needs Screening and Intervention (SNS-E): Food (PDF)
• Proportion of Days Covered (PDC) (PDF)

Otro

• Centene Vision Services
• Centene Dental Services

Provider Credentialing

• Allied and Advance Practice Nurse Credentialing Application (PDF)
• Medical Doctor or Doctor of Osteopathy Credentialing Application (PDF)

To see all coding tip sheets, please visit Coding Tip Sheets And Forms.

Ambetter Prior Authorization Statistics