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Manuals & Forms for Providers | Ambetter from Arkansas Health & Wellness
Provider Resources
Coronavirus (COVID-19)
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2020 Provider and Billing Manual (PDF)
- 2021 Provider and Billing Manual (PDF)
- Quick Reference Guide (PDF)
- ICD-10 Information
- Payspan (PDF)
- Secure Portal (PDF)
- Provider Portal Initiative FAQ (PDF)
- Envolve Vision Plan Specifics (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
Behavioral Health
- Discharge Consultation 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)
- OTR Tip Sheet (PDF)
- Psychological or Neuropsych Testing Authorization Request Form (PDF)
- Applied Behavioral Analysis Prior Authorization Request Form (PDF)
Claims and Claim Payment
Quality
- Practice Guidelines (PDF)
- Cultural Comptency Plan (PDF)
- Quality Improvement (QI)
- Ambetter Member Reassignment Form (PDF)
Provider Credentialing
Attention
If you would like to become a provider within our network, please fill out the Become A Provider form. Or call us at 1-844-631-6830 or by emailing ArkansasContracting@centene.com.
- Allied and Advance Practice Nurse Credentialing Application (PDF)
- Medical Doctor or Doctor of Osteopathy Credentialing Application (PDF)