Ambetter Provider Network Design | Ambetter from Coordinated Care


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Provider Network Design

Ambetter strives to provide access to a quality healthcare network with the goals of (1) keeping our premiums affordable and lowering costs for members and (2) focusing on making providers available who have a history of better healthcare outcomes. We want you to be and stay healthy!

To accomplish these goals, Ambetter contracts with a full range of practitioners and providers to provide all of the services that the Affordable Care Act describes as Essential Health Benefits. These include preventive care, hospitalization coverage, emergency services, and more. We make sure providers of all types are available within a certain geographic mileage or driving time from each of our members’ homes.

Ambetter contracts with providers who accept our contract terms, meet our credentialing criteria, and agree to our reimbursement terms. We regularly review the provider network and make decisions about which providers remain in the network based on many factors. These include:

  • Ensuring the availability of certain practitioners or hospitals in your area
  • The ability of providers to meet our credentialing criteria
  • Cost and efficient health care resource use data, to ensure your healthcare remains affordable
  • Comparison of quality metrics that examine performance based on measures such as proportion of patients receiving evidence-based care for chronic conditions, diabetes and preventive care, well child checkups and immunizations, and others.

For information about a provider's medical school and residency, call Member Services at 1-877-687-1197 (TTY/TDD 1-877-941-9238).

Hospital Quality Data

You can learn about the quality of hospitals near you by using Hospital Compare. Click here to start your search.