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Manuals & Forms for Providers | Ambetter from NH Healthy Families
Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2023 Provider & Billing Manual (PDF)
- 2022 Provider & Billing Manual (PDF)
- 2021 Provider & Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Prior Authorization Guide (PDF)
- Secure Portal (PDF)
- Payspan (PDF)
- ICD-10 Information
- 2022 Ambetter Provider Orientation (PDF)
- CAQH Provider Data Form (PDF)
- Billing Guidelines for Newborn Babies (PDF)
- NIA Physical Medicine Program Provider Training (PDF)
- Provider Change Form (PDF)
Medical Management/Behavioral Health
- Pre-Auth Needed?
- Inpatient Authorization Form (PDF)
- Outpatient Authorization Form (PDF)
- Non-OB Ultrasound Authorization Form (PDF)
- Discharge Consultation From (PDF)
- Behavioral Health Provider Specialty Profile (PDF)
- Prescription Fulfillment (PDF)
- Coordination of Care (PDF)
- Collaboration of Care: Medication Management (PDF)
- Transition Planning (PDF)
- Caregiver Training (PDF)
- Functional Behavior Assessments and Behavior Intervention Plans (PDF)
Claims & Claims Payment
- Claim Dispute Form (PDF)
- Explanation of Payment Request (PDF)
- CAH Billing Tip Sheet (PDF)
- Negative Balance Tip Sheet (PDF)
- Provider Negative Balance Request Form (PDF)
- No Surprises Act Open Negotiation Form (PDF)