Manuals and Forms for Providers | Ambetter of North Carolina
Provider Resources
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)
- Provider Booklet (PDF)
- Payspan (PDF)
- Quick Reference Guide (PDF)
- Secure Portal (PDF)
- ICD-10 Information
- 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)
New Provider Orientation
- Provider Orientation Presentation (PDF)
- Instructions for Attending a New Provider Orientation
- Provider Orientation 2024 Attestation of Completion
Claims and Claims Payment
- Claim Dispute Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)
- NEW: Claims and Billing Provider Guide - Upfront Rejections (PDF)
Quality Improvement
- HEDIS® Quick Reference Guide - Measurement Year 2023 (PDF)
- HEDIS® Adult Pocket Guide: 2022 Measurement Year (PDF)
- HEDIS® Pediatric Pocket Guide: 2022 Measurement Year (PDF)
- Supplemental Data System (SuDS) Submission Process (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)
- 2024 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
- 2024 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)