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

• Pharmacy Lock-in Program

Summary Guidelines

• Office of the Surgeon General - Centers for Disease Control (CDC) Guidelines: Turn the Tide Rx Prescribing Opioids for Pain (PDF)

Pain Management and Opioid Online Training 

• Complimentary Pain Management & Opioid Course (CME Credit Available) (PDF)

Fluvention

• Fluvention Flyer (PDF)

Other

• Provider Reconsideration and Appeal Request Form (PDF)
• CoverMyMeds Guide (PDF)
• Update and Certify Provider Data in CMS's NPPES (PDF)