Reference Materials

• 2026 Provider and Billing Manual (PDF)
• 2025 Provider and Billing Manual (PDF)
  
• Quick Reference Guide (PDF)
• Provider Engagement Manager Map (PDF)
• Pharmacy Guide (PDF)
• Care Options for Ambetter Health Patients (PDF)
• No Surprises Act
• Provider Frequently Asked Questions (FAQ) Flyer (PDF)
• 2025 Behavioral Health Measure Toolkit (PDF)
• Taxonomy Guide (PDF)
• Appointment Standards for Scheduling (PDF)
• Care Management (PDF)

Forms

• Inpatient Authorization Form (PDF)
• Outpatient Authorization Form (PDF)
• Provider Notification of Pregnancy (PDF)
• Step Therapy Form and Instructions (PDF)
• Interpreter Request Form (PDF)
  • Interpreter Services FAQs (PDF)
• Claim Dispute Form (PDF)

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 Health CMS Final Rule 0057-F Prior Authorization Requirements: 48286 (PDF)
• Ambetter Health Prior Authorization Metrics Summary: 48286 (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.

New Provider Orientation