Manuals & Forms for Providers | Ambetter of Tennessee
Provider Resources
Ambetter Health provides the tools and support you need to deliver the best quality of care.
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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 Orientation 2024 (PDF)
- Provider Orientation 2023 (PDF)
- Health Literacy and Culture (PDF)
- Telehealth and Virtual Services Guide (PDF)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- Provider Awareness Handout (PDF)
- Provider Awareness Flyer (PDF)
Quality Improvement
- Quick Reference Guide, HEDIS® MY 2023 (PDF)
- HEDIS® Adult Pocket Guide: 2023 Measurement Year (PDF)
- HEDIS® Pediatric Pocket Guide: 2023 Measurement Year (PDF)
- Quality Improvement (QI) Program
- Envolve Eye Exam for Patients with Diabetes (EED) Tip Sheet
- Marketplace P4P Program (PDF)
- CAHPS Provider Resource Guide (PDF)
- Provider CAHPS Tip Sheet (PDF)
- Supplemental Data System(SuDS) Submission Process (PDF)
- International Normalizing Ratio Monitoring for Individuals on Warfarin (INR) (PDF)
- Use of Imaging Studies for Low Back Pain (LBP) (PDF)
- Cervical Cancer Screening (CCS) (PDF)
- Chlamydia Screening in Women (CHL) (PDF)
- Controlling Blood Pressure (CBP) (PDF)
- Childhood Immunization Status (CIS) (PDF)
- Appropriate Testing for Pharyngitis (CWP) (PDF)
- Eye Exam for Patients with Diabetes (EED) (PDF)
- Immunizations for Adolescents (IMA) (PDF)
- Proportion of Days Covered: Diabetes All Class (PDC-DR) (PDF)
- Timeliness of Prenatal & Postpartum Care (PPC) (PDF)
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC) (PDF)
- Child and Adolescent Well-Care Visits (WCV) (PDF)
Risk Adjustment
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)
Behavioral Health
- Telehealth (TeleBH) (PDF)
- Suicide Awareness and Education
- Optimizing the AMM, FUH, and IET HEDIS Measures Training
- Improving Patient Engagement in Behavioral Healthcare (PDF)
- Enhancing Member Experience with Behavioral Health Care Services: Experience of Care and Health Outcomes (ECHO) Survey
- Behavioral Telehealth (PDF)
- Coordination of Care Checklist (PDF)
- PCP/BH Provider Communication Form (PDF)
- Improving Patient Engagement in Behavioral Healthcare (PDF)
- Follow-Up After Hospitalization for Mental Illness (PDF)
- Discharge Planner Checklist (PDF)
- Antipsychotic and Antidepressant Medication Adherence (PDF)
- Initiation and Engagement of Substance Use Disorder Treatment (IET) (PDF)
- CDC’s Efforts to Prevent Overdoses and Substance Use-Related Harms (PDF)
Claims and Claims Payment
- Provider Request for Reconsideration and Claim Dispute Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)
Quality
Credentialing
For newly contracted providers, please email forms to AmbetterTNNetwork@centene.com.
For existing network providers, please email forms to AmbetterTNOps@centene.com.