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Recursos para proveedores | Ambetter de Sunflower Health Plan
Recursos para proveedores
Ambetter brinda las herramientas y apoyo que usted necesita para dar atención de la mejor calidad.
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Materiales de referencias
- Manual del proveedor y de facturación 2026 (PDF)
- Manual del proveedor y de facturación 2025 (PDF)
- Access & Availability Standards (PDF)
- Guía de referencia rápida (PDF)
- Pharmacy Guide (PDF)
- Claims, Disputes & Recovery/CCU Guide (PDF)
- Información sobre la CIE-10
- PaySpan (PDF)
- Portal seguro (PDF)
- Ambetter Claim Reconsideration and Appeal Quick Reference Guide (PDF)
- Appointment Standards for Scheduling (PDF)
- Interpreter Request Form (PDF)
- Care Management (PDF)
Administración médica
- ¿Necesita preautorización?
- Guía de autorización previa (PDF)
- Electroconvulsive Therapy Authorization Form (PDF)
- Formulario de impuestos de autorización previa para pacientes internos (PDF)
- Formulario de impuestos de autorización previa para pacientes externos (PDF)
- Intensive Outpatient/Day Treatment Authorization Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Supplemental Form (PDF) - This is an optional page meant to be used in conjunction with the Sunflower's Outpatient Prior Authorization Request form when a request exceeds more than four procedure codes. This page should never be submitted alone.
- Outpatient Treatment Request Form (PDF)
- Provider Fax Back Form (PDF)
- Applied Behavioral Analysis Authorization Form (PDF)
- Birth Event Notification (PDF): Optional form to report birth events/outcomes
- Neuropsychological Testing Authorization Request Form (PDF)
- Transcranial Magnetic Stimulation (TMS) Request Form (PDF)
- Behavioral Health Outpatient Psychological Testing Request Form (PDF)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- Medical Necessity Criteria
- Discharge Planner Checklist (PDF)
Reclamaciones y pago de reclamaciones
- Provider Request for Reconsideration and Claim Dispute Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)
Calidad
- Mejoramiento de Calidad (Quality Improvement, QI)
- Practice Guidelines (PDF)
- Providing Quality Care
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Otro
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 from Sunflower Health CMS Final Rule 0057-F Prior Authorization Requirements: 34368 (PDF)
- Ambetter from Sunflower Health Prior Authorization Metrics Summary: 34368 (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.