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

Haga clic aquí para ver nuestro calendario de próximas capacitaciones para proveedores.

To find out how to contact your Provider Representative, please visit Find My Provider Representative.

Materiales de referencia

• 2025 Provider & Billing Manual (PDF)
  
• 2024 Provider & Billing Manual (PDF)
  
• Quick Reference Guide (PDF)
• Pharmacy Guide (PDF)
• Appeals and Grievances Guide (PDF)
• Claims, Disputes & Recovery/CCU Guide (PDF)
• Prior Authorization Guide (PDF)
• ICD-10 Information
• W-9 Fax Cover Sheet (PDF)
• Ambetter Provider Toolkit
• 2025 Provider Training (PDF)
• 2024 Provider Training (PDF)
• Find a Provider Guide (PDF)
• Quick Reference Guide: How to Identify an In-Network Provider (PDF)
• Secure Provider Portal - Quick reference Guide: How to Verify Eligibility (PDF)
• Secure Provider Portal - How to Make PCP Referral for Value and Virtual Plans (PDF)
• Non-Formulary And Step Therapy Exception Request Form (PDF)
• INR Monitoring for Individuals on Warfarin (PDF)
• Provider Attestation Statement: Allergy Immunotherapy for Non-Allergists (PDF)
• Provider Attestation Statement: Allergy Skin Testing and Immunotherapy for Non-Allergists (PDF)

Administración médica

• Pre-Auth Needed?
• Outpatient Prior Authorization Fax Form (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Authorization and Coverage Complaints
• Biopharmacy Outpatient Prior Authorization Form (J-code products) (PDF)
• House Bill 3459 Preauthorization Exemption Program (PDF)
• Specialist as PCP Request Form (PDF)

Salud del comportamiento

• Discharge Consultation Documentation Fax Form (PDF)
• Discharge Planner Checklist (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Formulario de solicitud de cambio de proveedor (PDF)
• Transcranial Magnetic Stimulation Services Prior Authorization Checklist (PDF)
• Psychological and Neuropsychological Testing Checklist (PDF)
• Electroconvulsive Therapy (ECT) Checklist (PDF)
• Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)

Reclamaciones y pago de reclamaciones

• Claim Dispute Form (PDF)
• Billing and Coding
• No Surprises Act Open Negotiation Form (PDF)
  
• FQHC Quick Reference Guide (PDF)

Calidad

Maintaining accreditation is Ambetter’s long-standing commitment to provide quality health-care service and programs to your patients. The goal of our Quality Improvement Program is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings. Learn more about our Quality Improvement activities. 

• Practice Guidelines (PDF)
• Quality Improvement (QI)

Otro

• Centene Vision Services
• Centene Dental Services