Manuals & Forms for Providers | Ambetter of Tennessee
Provider Resources
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.
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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)
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.