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Manuals & Forms for Providers | Ambetter from SilverSummit HealthPlan
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 & Billing Manual (PDF)
- Quick Reference Guide (PDF)
- ICD-10 Information
- Payspan (PDF)
- Secure Portal (PDF)
- Claim Dispute Form (PDF)
Medical Management
- Pre-Auth Needed?
- Prior Authorization Guide (PDF)
- Electroconvulsive Therapy Authorization Form (PDF)
- Inpatient Prior Authorization Fax Form (PDF)
- Intensive Outpatient/Day Treatment Authorization Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Outpatient Treatment Request Form (PDF)
- Psychological or Neuropsych Testing Authorization Form (PDF)
- Provider Fax Back Form (PDF)
- Applied Behavioral Analysis Authorization Form (PDF)