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Provider Manuals & Forms | Ambetter from Nebraska Total Care
Provider Resources
Ambetter provides the tools and support you need to deliver the best quality of care.
Reference Materials
- 2022 Provider and Billing Manual (PDF)
- Inpatient Authorization Form (PDF)
- Outpatient Authorization Form (PDF)
- Well-Being Survey (PDF)
- Member Notification of Pregnancy (PDF)
- Notification of Pregnancy Form (PDF)
- Known Issues and Resolution Timeframes
- No Surprises Act Open Negotiation Form (PDF)
National Imaging Associates (NIA) Documents
- National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ’s) Prior Authorization Program Physical Medicine Services (PDF)
- Physical Medicine Program Provider Training (PDF)
- Physical Medicine Prior Authorization Quick Reference Guide for Providers (PDF)
- Physical Medicine Request Tip Sheet/Checklist (PDF)
- RadMD Access for Physical Medicine Providers to Request Prior Authorization (PDF)
- RadMD Quick Start Guide Physical Medicine Authorization Requests (PDF)