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HAVE AN ENROLLMENT NEED? SHOP OUR PLANS
Main Menu
-
Our Health Plans
show Our Health Plans menu
-
- About Our Plans
- Our Benefits
- My Health Pays Rewards®
- Coverage Area Map
- Ways to Save
- What is Ambetter Health?
- Shop and Compare Plans
- Find a Doctor
Use your ZIP Code to find your personal plan.
- See coverage in your area
- Find doctors and hospitals
- View pharmacy program benefits
- View essential health benefits
Find and enroll in a plan that's right for you.
-
-
Join Ambetter Health
show Join Ambetter Health menu
-
- Four easy steps is all it takes
- What you need to enroll
- Special Enrollment Information
-
-
For Members
show For Members menu
-
- Pay Now
- Find a Doctor
- Drug Coverage
- Forms and Materials
- Ways to Pay
- New Members
- Renew Your Plan
- Better Health Center
- The Better Bulletin
- Member News
- Medicare Eligible
- Health Savings Account
Find everything you need in the member online account
- View your claims
- Review your plan benefits
- Print your ID card
- View rewards points total
-
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)
- Providing Quality Care
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)