Provider Resources

Ambetter provides the tools and support you need to deliver the best quality of care.

Reference Materials

• 2018 Provider and Billing Manual (PDF)
• 2019 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• Wellness and Preventive Services Fact Sheet (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

Prior Authorizations Monthly Data

• June 2015 Inpatient Authorization Statistics (PDF)
  
• June 2015 Inpatient Authorizations Summary (PDF)
• June 2015 Outpatient Authorizations Statistics (PDF)
• June 2015 Outpatient Authorizations Summary (PDF)
• June 2015 Count of Service Status (PDF)

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)

Claims and Claim Payment

• Electronic Transactions (PDF)
• Claim Dispute Form (PDF)

Quality

• HEDIS Guide (PDF)
• Clinical Practice Guidelines
• Cultural Comptency Plan (PDF)
• LBP & AAB (PDF)
• Pay for Performance (P4P) HEDIS Quick Reference Guide (PDF)
• Quality Improvement (QI)

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)