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Provider Manuals and Forms | Ambetter from Home State Health
Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2023 Provider and Billing Manual (PDF)
- 2022 Provider and Billing Manual (PDF)
- 2021 Provider and Billing Manual (PDF)
- COVID-19 Vaccine Patient Engagement Tips (PDF)
- COVID-19 Notice of Vaccine - Billing Guidelines (PDF)
- COVID-19 Extended Coverage (PDF)
- COVID-19 Provider Information (PDF)
- COVID-19 Guidance for Providing In-Home Care Services (PDF)
- COVID-19 Treatment and Telehealth Services (PDF)
- Quick Reference Guide (PDF)
- ICD-10 Information
- Payspan (PDF)
- Secure Portal (PDF)
- Ambetter Taxonomy (PDF)
- Payment Policy Update (PDF)
- Ophthalmology Provider Transition Quick Reference Guide (PDF)
- Hemophilia Network Posting
- TurningPoint Healthcare Solutions
- In-Home Test Kits (PDF)
- No Surprises Act Open Negotiation Form (PDF)
- RadMD Cardiac Provider Experience Workgroups (PDF)
Medical Management/Behavioral Health
- Pre-Auth Needed?
- Prior Authorization Guide (PDF)
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Provider Fax Back Form (PDF)
- MO Marketplace Out of Network Form (PDF)
- Ambetter from Home State Health Oncology Pathway Solutions FAQs (PDF)
- National Imaging Associates, Inc. FAQs (PDF)
- Physical Medicine Prior Authorization QRG - NIA (PDF)
- NIA Utilization Review Matrix Ambetter - 2023 (PDF)
Quality
- Quality Improvement (QI)
- Practice Guidelines (PDF)
- Controlling High Blood Pressure Coding Sheet (PDF)
- Payment and Clinical Policies (PDF)
- HEDIS 2021 QRG (PDF)
Opioid Toolkit
Summary Guidelines
Pain Management and Opioid Online Training
Fluvention
Other
- Provider Reconsideration and Appeal Request Form (PDF)
- CoverMyMeds Guide (PDF)
- Update and Certify Provider Data in CMS's NPPES (PDF)