Reference Materials

• 2022 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• Ambetter Authorization Lookup (PDF)
• Payspan (PDF)
• Secure Portal (PDF)
• ICD-10 Information
• Referral Notice for Providers
• Ambetter Balance Billing Reminder

Behavioral Health

• OTR Completion Tip Sheet (PDF)
• Discharge Consultation 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)

Claims

• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)

Quality

• Practice Guidelines (PDF)
• HEDIS Quick Reference Guide (PDF)
• Quality Improvement (QI)