Reference Materials

• 2020 Provider and Billing Manual (PDF)
• 2021 Provider and Billing Manual (PDF)
  
• ICD-10 Information
• Provider Toolkit
• HEDIS 2021 Quick Reference Guide (PDF)
• Cultural Competency Provider Training
  

Medical Management

• Pre-Auth Needed?
• Prior Authorization Guide
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Grievance and Appeals
• Provider Notification of Pregnancy Form (PDF)

Behavioral Health

• Discharge Consultation Form (PDF)
• OTR Completion Tip Sheet (PDF)
• Psychological or Neuropsych Testing Authorization Request Form (PDF)
• Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
• Intensive Outpatient/Day Treatment Form for Mental Health/Chemical Dependency (PDF)
• Outpatient Treatment Request Form (PDF)
• Behavioral Health HEDIS Provider Toolkit (PDF)
• Suicide Prevention (PDF)

Claims and Claim Payment

• Claim Dispute Form (PDF)
• Ambetter Taxonomy Guide (PDF)

Quality

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

Continuity of Care Program

• Continuity of Care Booklet (PDF)
• Continuity of Care Early Submitter Bonus (PDF)

Other

• Covered Services and Authorization Grid (PDF)
• Provider Territory List