Provider Manuals and Forms | Ambetter from Home State Health
Provider Resources
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2024 Provider and Billing Manual (PDF)
- 2023 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)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- Spine Surgery - Evolent Utilization Matrix (PDF)
- Joint Surgery - Evolent Utilization Matrix (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)