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NEED HEALTH INSURANCE? SHOP OUR PLANS.External Link
Manuals & Forms for Providers | Ambetter from Buckeye Health Plan
Provider Resources
Ambetter Health provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2025 Provider & Billing Manual (PDF)
- 2024 Provider & Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Prior Authorization Guide (PDF)
- Prior Auths Removed 3-31-21 (PDF)
- Secure Portal (PDF)
- Payspan (PDF)
- ICD-10 InformationExternal Link
- Electronic Transactions (PDF)
- Ambulatory Surgery Center Optimization Codes (PDF)
- NIA Physical Medicine Request Checklist (PDF)
- NIA Physical Medicine Services FAQs (PDF)
- NIA Expanded Partnership Provider Letter (PDF)
- National Imaging Associates, Inc. (NIA)’s Peer-to-Peer Process (PDF)
- Ambetter Prior Authorization Changes - Effective 10/01/2021 (PDF)
- Ambetter Prior Authorization Change Notification Changes Effective 11/1/21 (PDF)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- 2023 Provider Orientation (PDF)
- RSV Flyer (PDF)
- 2025 Example Member ID Card - Premier (PDF)
- 2025 Example Member ID Card - Solutions (PDF)
Medical Management/Behavioral Health
- Pre-Auth Needed?
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Supplemental Outpatient Prior Authorization Form (PDF)
- CDMS Barcoded Form Disclosure (PDF)
- Grievance and Appeals
- BH - Discharge Consultation Form (PDF)
- BH - SMART Goals Fact Sheet (PDF)
- Discharge Planner Checklist (PDF)
Claims and Claim Payment
Quality
- Practice Guidelines (PDF)
- Quality Improvement (QI)
- Notification of Pregnancy Form (PDF)
- Providing Quality Care