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HAVE AN ENROLLMENT NEED? SHOP OUR PLANS
Main Menu
-
Our Health Plans
show Our Health Plans menu
-
- About Our Plans
- Our Benefits
- My Health Pays Rewards®
- Coverage Area Map
- Ways to Save
- What is Ambetter Health?
- Shop and Compare Plans
- Find a Doctor
- Washington Healthplanfinder
Use your ZIP Code to find your personal plan.
- See coverage in your area
- Find doctors and hospitals
- View pharmacy program benefits
- View essential health benefits
Find and enroll in a plan that's right for you.
-
-
Join Ambetter Health
show Join Ambetter Health menu
-
- Four easy steps is all it takes
- What you need to enroll
- Special Enrollment Information
-
-
For Members
show For Members menu
-
- Pay Now
- Find a Doctor
- Drug Coverage
- Forms and Materials
- Ways to Pay
- New Members
- Renew Your Plan
- Better Health Center
- The Better Bulletin
- Vision Benefits
- Pharmacy FAQ
- Member News
- Mental Health Resources
Find everything you need in the member online account
- View your claims
- Review your plan benefits
- Print your ID card
- View rewards points total
-
Provider Manuals and Forms | Ambetter from Coordinated Care
Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2024 Provider & Billing Manual (PDF)
- 2023 Provider & Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Prior Authorization Guide (PDF)
- New Century Health FAQ (PDF)
- Secure Portal (PDF)
- Payspan (PDF)
- ICD-10 Information
- My Health Pays Provider Educational Flyer (PDF)
- Waiting Room Quick Guide Card (PDF)
- Provider Update Tools
Health Equity Resources
Medical Management
- Pre-Auth Needed?
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Grievance and Appeals
- Durable Medical Equipment (DME) Form (PDF)
- Breast Pump Request Form (PDF)
- Sterilization Consent Form (PDF)
- Biopharmacy/Buy-bill Prior Authorization Form (PDF)
Behavioral Health
- Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
- OTR Completion Tip Sheet (PDF)
- Psychological or Neuropsych Testing Authorization Request Form (PDF)
- Applied Behavioral Analysis Prior Authorization Request Form (PDF)
- Outpatient/ Inpatient Behavioral Health Service Authorization Request Form (PDF)
Vision
Ophthalmology Services
Claims and Claim Payment
- Request for Out of Network Payment Evaluation (PDF)
- Claims and Payment Decision Tree (PDF)
- Claims Trend Form (PDF)
- Provider Claims FAQ (PDF)
Quality Improvement
- Practice Guidelines (PDF)
- Quality Improvement (QI)
- Member Notification of Pregnancy (PDF)
- Member Notification of Pregnancy (PDF) (Spanish)
- Providing Quality Care
Reconsideration Resources
- Reconsideration Grid (PDF)
- Change in Condition (PDF)
- Claim Reconsideration and Dispute Form (PDF)
- Re-Review Request Form (PDF)