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)
• Quick Reference Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• Provider Portal Enhancements: Claim Reconsideration and Denial Explanations (PDF)
• Provider Town Hall (PDF)
  
• No Surprises Act Open Negotiation Form (PDF)
  
• Ambetter Provider Claim Reconsideration/Dispute Form (PDF)
• Non-Formulary And Step Therapy Exception Request Form (PDF)

Medical Management/Behavioral Health

• Prior Authorization Guide (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF) - Do NOT use for medication request - Effective 03/20/2024
• Notification of Pregnancy (NOP) Form (PDF)
• Pharmacy Forms

Quality

• Quality Improvement (QI) Program
• Practice Guidelines (PDF)
• Culturally and Linguistically Appropriate Services (CLAS) (PDF)
• Providing Quality Care

National Imagine Associates (NIA)

• NIA Website

Provider Training

• Ambetter Provider Education and Training (PDF)
• A Physician’s Practical Guide to Culturally Competent Care
• Provider Training Attestation (PDF) 

New Century Health - Oncology

All oncology-related chemotherapeutic drugs and supportive agents will require prior authorization from New Century Health (NCH) before being administered in a physician’s office, outpatient hospital, or ambulatory setting.
This process applies to both Medical Benefit (Buy and Bill Request) AND Pharmacy Services (Retail Pharmacy)

Pre-Approval Process

The requesting physician must complete an authorization request using one of the following methods:

• Log in to the NCH Provider Web Portal at https://my.newcenturyhealth.com.
• Call 1-888-999-7713 and select option 1, from 8 a.m. to 8 p.m. EST, Monday through Friday. General New Century Health Information.
• New Century Health FAQ (PDF)