¡Bienvenido(a), afiliado(a)! Pague su prima para mantener la cobertura que se merece en 2024. Pague ahora
Recursos para proveedores
Recursos para proveedores
Ambetter brinda las herramientas y apoyo que usted necesita para dar atención de la mejor calidad.
Sign up for the Ambetter of Tennessee quarterly newsletter for providers. Be the first to know about policy updates, quality incentives, and our impact in the community. Get Started.
Materiales de referencias
- 2024 Provider and Billing Manual (PDF)
- 2023 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)
- Provider Orientation 2024 (PDF)
- Provider Orientation 2023 (PDF)
- Health Literacy and Culture (PDF)
- Telehealth & Virtual Services Guide (PDF)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
- Provider Awareness Handout (PDF)
- Provider Awareness Flyer (PDF)
Mejoramiento de la calidad
- Quick Reference Guide, HEDIS® MY 2024 (PDF)
- HEDIS® Adult Pocket Guide: 2024 Measurement Year (PDF)
- HEDIS® Pediatric Pocket Guide: 2024 Measurement Year (PDF)
- Quality Improvement (QI) Program
- HEDIS Training and Tips
- 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)
- International Normalizing Ratio Monitoring for Individuals on Warfarin (INR) (PDF)
- Use of Imaging Studies for Low Back Pain (LBP) (PDF)
- Cervical Cancer Screening (CCS) (PDF)
- Chlamydia Screening in Women (CHL) (PDF)
- Controlling Blood Pressure (CBP) (PDF)
- Childhood Immunization Status (CIS) (PDF)
- Appropriate Testing for Pharyngitis (CWP) (PDF)
- Eye Exam for Patients with Diabetes (EED) (PDF)
- Immunizations for Adolescents (IMA) (PDF)
- Proportion of Days Covered: Diabetes All Class (PDC-DR) (PDF)
- Timeliness of Prenatal & Postpartum Care (PPC) (PDF)
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC) (PDF)
- Child and Adolescent Well-Care Visits (WCV) (PDF)
- Respiratory Syncytial Virus (RSV) (PDF)
Ajuste de riesgos
- Continuity of Care Program (PDF)
- Continuity of Care Program Appointment Agenda (PDF)
- 2024 Tiered Incentive Payments (PDF)
Administración médica
- Prior Authorization Guide
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Prior Authorization Request Form for Non-Specialty Drugs (PDF)
Salud del comportamiento
- Telehealth (TeleBH) (PDF)
- Suicide Awareness and Education
- Optimizing the AMM, FUH, and IET HEDIS Measures Training
- Improving Patient Engagement in Behavioral Healthcare (PDF)
- Coordination of Care Checklist (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)
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Reclamaciones y pago de reclamaciones
- Provider Request for Reconsideration and Claim Dispute Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)
Calidad
Credentialing
For newly contracted providers, please email forms to AmbetterTNNetwork@centene.com.
For existing network providers, please email forms to AmbetterTNOps@centene.com.