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Manuals & Forms for Ambetter Providers | Ambetter of Illinois
Provider Resources
Coronavirus (COVID-19)
Notice
ALL PROVIDERS must complete and submit a new provider roster by March 12, 2021. Email rosters to providerrosters.il@mhplan.com.
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2020 Provider and Billing Manual (PDF)
- 2021 Provider and Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Prior Authorization Guide (PDF)
- Payspan (PDF)
- Secure Portal (PDF)
- ICD-10 Information
- Referral Notice for Providers
Behavioral Health
- OTR Completion Tip Sheet (PDF)
- Discharge Consultation Form (PDF)
- Psychological or Neuropsych Testing Authorization Request Form (PDF)
Medical Management
- Pre-Auth Needed?
- Prior Authorization Quick Reference Guide (PDF)
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Grievance and Appeals