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Welcome, member! Pay your premium to keep the 2024 coverage you deserve. Pay Now
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 Health provides the tools and support you need to deliver the best quality of care.
Locate your Provider Engagement, Community Relations and Wellcare representative - View Regional Rep Contacts
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
Provider Training
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)