Ambetter Health brinda las herramientas y el apoyo que necesita para ofrecer atención de la mejor calidad.

Reference Materials

• 2026 Provider and Billing Manual (PDF)
• 2025 Provider and Billing Manual (PDF)
• Provider Booklet (PDF)
• Quick Reference Guide (PDF)
• Pharmacy Guide (PDF)
• Claims, Disputes & Recovery/CCU Guide (PDF)
• Payspan (PDF)
• Secure Portal (PDF)
• ICD-10 Information
• Taxonomy Reference Guide (PDF)
• Provider Portal Enhancements (PDF)
• Payspan Provider Training
• Behavioral Health Resources
• Non-Formulary And Step Therapy Exception Request Form (PDF)
• Ambetter of North Carolina Inc. General Flyer (PDF)
• Ambetter of North Carolina Inc. Network Flyer (PDF)
• Respiratory syncytial virus (RSV) Provider Guide (PDF)
• Ambetter Preventative Care (PDF)
• 2025 Provider Appointment Standards for Scheduling (PDF)
• Care Options for Ambetter Patients (PDF)
• Ambetter of North Carolina Inc. Network Flyer (PDF)
• Interpreter Request Form (PDF)

New Provider Orientation

• Welcome Letter (PDF)
• Quick Reference Guide (PDF)
• Provider Orientation Presentation (PDF)
• Instructions for Attending a New Provider Orientation
• Provider Orientation Attestation of Completion

Claims and Claims Payment

• Claim Dispute Form (PDF)
• Consent for Sterilization Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)
• NEW: Claims and Billing Provider Guide - Upfront Rejections (PDF)

Practitioner Enrollment and Provider Demographic Updates

• Requests to join our network are not processed using these forms. To request to join our network, please use our Network Participation Request Form. Once you have completed this form, please allow up to five business days days for a member of our team to contact you.
• To add a new facility to an existing application or to submit location changes, please download and fill out the Ambetter Facility Roster Template (Excel | .xlsm) and submit these forms along with all credentialing documentation to AmbetterNCProviderDirectoryRequest@CENTENE.COM.
• To add a new practitioner to your practice, please download and fill out the Ambetter Practitioner Roster Template (Excel | .xlsm) and submit these forms along with all credentialing documentation to AmbetterNCProviderDirectoryRequest@CENTENE.COM.

Health Equity Toolkit

• Help Your Patients Understand Their Health and Health Care (PDF)
• AHRQ Health Literacy Universal Precautions Toolkit

Quality Improvement

• HEDIS® Quick Reference Guide Measurement Year 2025 (PDF)
• HEDIS® Adult Pocket Guide: 2025 Measurement Year (PDF)
• HEDIS® Pediatric Pocket Guide: 2025 Measurement Year (PDF)
• Supplemental Data System (SuDS) Submission Process (PDF)
• The Supplemental Data Journey Flyer (PDF)
• 2021 QUALITY RATING SYSTEM (QRS) AT-A-GLANCE (PDF)
• Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Provider Resource Guide (PDF)
• Improve Patient Experience (PDF)
• 2025 Marketplace P4P Program (PDF)

Risk Adjustment

• 2025 Continuity of Care Program Guide (PDF)
  
• Continuity of Care Appointment Agenda (PDF)
• Continuity of Care Program Tiered Incentive Payment Chart (PDF)

Medical Management

• Prior Authorization Guide
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)
• Clinical Policy: Brand Name Override and Non-Formulary Medications (PDF)
• Retrospective Authorization Review Request (PDF)
• Discharge Planner Checklist (PDF)

Quality

• Practice Guidelines (PDF)
• Providing Quality Care
• Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)

Notification of Pregnancy Provider Report

• Notification of Pregnancy Report Provider Education (PDF)
• Notification of Pregnancy Report Flyer (PDF)

Other

• Centene Vision Services
• Centene Dental Services