Ambetter brinda las herramientas y apoyo que usted necesita para dar atención de la mejor calidad.

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Materiales de referencias

• 2025 Provider and Billing Manual (PDF)
  
• 2024 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• HEDIS® 2020 Tip Sheet (PDF)
• HEDIS® Quick Reference Guide (PDF)
• CPT II Codes Tip Sheet (PDF)
• Provider Orientation 2025 (PDF)
• Provider Orientation 2024 (PDF)
• Health Literacy and Culture (PDF)
• Telehealth & Virtual Services Guide (PDF)
• Non-Formulary And Step Therapy Exception Request Form (PDF)
• Provider Awareness Handout (PDF)
• Provider Awareness Flyer (PDF)
• Provider Rep. Territory Contact List (PDF)

Mejoramiento de la calidad

• Quick Reference Guide, HEDIS® MY 2024 (PDF)
• HEDIS® Adult Pocket Guide: 2024 Measurement Year (PDF)
  
• HEDIS® Pediatric Pocket Guide: 2024 Measurement Year (PDF)
  
• Quality Improvement (QI) Program
• HEDIS Training and Tips
• Centene Vision Services Eye Exam for Patients with Diabetes (EED) Tip Sheet
• Marketplace P4P Program (PDF)
• 2024 Pay for Performance (PDF)
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) (PDF)
• Provider CAHPS Tip Sheet (PDF)
• Supplemental Data System(SuDS) Submission Process (PDF)
• International Normalizing Ratio Monitoring for Individuals on Warfarin (INR) (PDF)
• Use of Imaging Studies for Low Back Pain (LBP) (PDF)
• Cervical Cancer Screening (CCS) (PDF)
• Chlamydia Screening in Women (CHL) (PDF)
• Controlling Blood Pressure (CBP) (PDF)
• Childhood Immunization Status (CIS) (PDF)
• Appropriate Testing for Pharyngitis (CWP) (PDF)
• Eye Exam for Patients with Diabetes (EED) (PDF)
• Immunizations for Adolescents (IMA) (PDF)
• Proportion of Days Covered: Diabetes All Class (PDC-DR) (PDF)
• Timeliness of Prenatal & Postpartum Care (PPC) (PDF)
• Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC) (PDF)
• Child and Adolescent Well-Care Visits (WCV) (PDF)
• Respiratory Syncytial Virus (RSV) (PDF)

Ajuste de riesgos

• Continuity of Care Program (PDF)
• Continuity of Care Program Appointment Agenda (PDF)
• 2024 Tiered Incentive Payments (PDF)

Administración médica

• Prior Authorization Guide
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form Continuation (PDF)
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)

Salud del comportamiento

• Telehealth (TeleBH) (PDF)
  
• Suicide Awareness and Education
• Optimizing the AMM, FUH, and IET HEDIS Measures Training (PDF)
• Coordination of Care Checklist (PDF)
• Behavioral Telehealth (PDF)
• Coordination of Care Checklist (PDF)
• PCP/BH Provider Communication Form (PDF)
• Improving Patient Engagement in Behavioral Healthcare (PDF)
• Follow-Up After Hospitalization for Mental Illness (PDF)
• Discharge Planner Checklist (PDF)
• Antipsychotic and Antidepressant Medication Adherence (PDF)
• Initiation and Engagement of Substance Use Disorder Treatment (IET) (PDF)
• Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
• CDC’s Efforts to Prevent Overdoses and Substance Use-Related Harms

Reclamaciones y pago de reclamaciones

• Provider Request for Reconsideration and Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)
  

Calidad

• Practice Guidelines (PDF)
• Providing Quality Care

Claims and Claims Payment 

• Consent for Sterilization Form (PDF)
  

Credentialing

For newly contracted providers, please email forms to AmbetterTNNetwork@centene.com.
For existing network providers, please email forms to AmbetterTNOps@centene.com.

• Credentialing Checklist (PDF)

Otro

• Centene Vision Services
• Centene Dental Services