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Manuals and Forms | Ambetter from Peach State Health Plan
Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Add plan specific forms and manuals here
Reference Materials
- 2020 Provider and Billing Manual (PDF)
- ICD-10 Information
- Quick Reference Guide (PDF)
- Payspan (PDF)
- Secure Portal (PDF)
- HEDIS 2020 Quick Reference Guide (PDF)
Medical Management
- Pre-Auth Needed?
- Prior Authorization Guide (PDF)
- 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
Quality
Other
