¿NECESITAS UN SEGURO DE SALUD? COMPRA NUESTROS PLANES.Sitio Externo
Recursos para proveedores
Recursos para proveedores
Ambetter brinda las herramientas y el apoyo que necesita para ofrecer atención de la mejor calidad.
Reference Materials
- 2025 Provider and Billing Manual (PDF)
- 2024 Provider and Billing Manual (PDF)
- Provider Booklet (PDF)
- Quick Reference Guide (PDF)
- Pharmacy Guide (PDF)
- Claims, Disputes & Recovery/CCU Guide (PDF)
- Appeals/Reconsiderations (Medical) And Grievances Guide (PDF)
- Payspan (PDF)
- Secure Portal (PDF)
- ICD-10 InformationSitio Externo
- Taxonomy Reference Guide (PDF)
- Provider Portal Enhancements (PDF)
- Payspan Provider Training
- Behavioral Health Resources
- NEW for 2023: Fight Against the Flu Provider Guide (PDF)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- Ambetter of North Carolina Inc. General Flyer (PDF)
- Ambetter of North Carolina Inc. Network Flyer (PDF)
- Respiratory syncytial virus (RSV) Provider Guide (PDF)
- Ambetter Preventative Care (PDF)
- 2025 Provider Appointment Standards for Scheduling (PDF)
- Care Options for Ambetter Patients (PDF)
New Provider Orientation
- Welcome Letter (PDF)
- Quick Reference Guide (PDF)
- Provider Orientation Presentation (PDF)
- Instructions for Attending a New Provider Orientation
- Provider Orientation Attestation of Completion
Claims and Claims Payment
- Claim Dispute Form (PDF)
- Consent for Sterilization Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)
- NEW: Claims and Billing Provider Guide - Upfront Rejections (PDF)
Health Equity Toolkit
- Help Your Patients Understand Their Health and Health Care (PDF)
- AHRQ Health Literacy Universal Precautions ToolkitSitio Externo
Quality Improvement
- HEDIS® Quick Reference Guide - Measurement Year 2024 (PDF)
- HEDIS® Adult Pocket Guide: 2024 Measurement Year (PDF)
- HEDIS® Pediatric Pocket Guide: 2024 Measurement Year (PDF)
- Supplemental Data System (SuDS) Submission Process (PDF)
- The Supplemental Data Journey Flyer (PDF)
- 2021 QUALITY RATING SYSTEM (QRS) AT-A-GLANCE (PDF)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Provider Resource Guide (PDF)
- Improve Patient Experience (PDF)
- 2025 Marketplace P4P Program (PDF)
- Provider Tip Sheets
- Appropriate Testing for Pharyngitis (CWP) (PDF)
- Cervical Cancer Screening (CCS) Tip Sheet (PDF)
- Childhood Immunizations Status (CIS) (PDF)
- Child and Adolescent Well-Care Visits (WCV) (PDF)
- Chlamydia Screening in Women (CHL) (PDF)
- Controlling Blood Pressure (CBP) (PDF)
- Eye Exam for Patients with Diabetes (EED) (PDF)
- Immunization for Adolescents (IMA) (PDF)
- International Normalizing Ratio Monitoring for Individuals on Warfarin (INR) (PDF)
- Proportion of Days Covered: Diabetes All Class (PDC-DR) (PDF)
- Timeliness of Prenatal & Postpartum Care (PPC) (PDF)
- Use of Imaging Studies for Low Back Pain (LBP) (PDF)
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC) (PDF)
Risk Adjustment
- 2025 Continuity of Care Program Guide (PDF)
- Continuity of Care Appointment Agenda (PDF)
- Continuity of Care Program Tiered Incentive Payment Chart (PDF)
Medical Management
- Prior Authorization Guide
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Prior Authorization Request Form for Non-Specialty Drugs (PDF)
- Clinical Policy: Brand Name Override and Non-Formulary Medications (PDF)
- Retrospective Authorization Review Request (PDF)
- Discharge Planner Checklist (PDF)
Quality
- Practice Guidelines (PDF)
- Providing Quality Care
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Notification of Pregnancy Provider Report
- Notification of Pregnancy Report Provider Education (PDF)
- Notification of Pregnancy Report Flyer (PDF)