Materiales de referencias

• 2023 Provider and Billing Manual (PDF)
  
• 2022 Provider and Billing Manual (PDF)
  
• 2021 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• HEDIS® 2020 Tip Sheet (PDF)
• HEDIS® Quick Reference Guide (PDF)
• CPT II Codes Tip Sheet (PDF)
• 2022 Network Overview (PDF)
• Provider Orientation (PDF)
  

Mejoramiento de la calidad/Ajuste de riesgos

• HEDIS® MY 2021 (PDF)
• 2021 QUALITY RATING SYSTEM (QRS) AT-A-GLANCE (PDF)
• Quality Improvement (QI) Program

Administración médica

• Prior Authorization Guide
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Biopharmacy Outpatient Prior Authorization Fax Form (PDF)
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)

Reclamaciones y pago de reclamaciones

• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)
  

Calidad

• Practice Guidelines (PDF)

Credentialing

For newly contracted providers, please email forms to AmbetterTNNetwork@centene.com.
For existing network providers, please email forms to AmbetterTNOps@centene.com.

• Credentialing Checklist (PDF)