When does the Ambetter fee schedule change?
Date: 12/02/19 Ambetter from Superior HealthPlan (Marketplace) appreciates your partnership as we achieve our shared goal of delivering quality, accessible and affordable healthcare to our members. Starting January 1, 2020, the Ambetter fee schedule name will change from Payor Medicare Fee Schedule to Payor Fee Schedule.
What is Ambetter from Superior HealthPlan?
Provider and Billing Manual 2022 Ambetter.SuperiorHealthPlan.com AMB21-TX-HLK-00073 Ambetter from Superior HealthPlan includes EPO products that are underwritten by Celtic Insurance Company, and HMO products that are underwritten by Superior HealthPlan. © 2022 Superior HealthPlan. All rights reserved. 1 TABLE OF CONTENTS WELCOME 7
How can I request additional information about Ambetter's Qapi program?
Ambetter providers may request additional information on the health plan programs, including a description of the QAPI Program and a report on Ambetter’s progress in meeting QAPI Program goals, by contacting the QI Department. Quality Rating System Healthcare Effectiveness Data and Information Set (HEDIS)
What is the payer ID number for Ambetter?
Submitting Claims Through A Clearinghouse: Ambetter Payer ID number for all clearinghouses (Medical and Behavioral Health) is 68069. We use Availity as our primary clearinghouse, which provides us wit h an extensive network of connectivity.
What is Ambetter committed to?
Ambetter is committed to assisting its provider community by supporting their efforts to deliver well- coordinated and appropriate health care to our members. Ambetter is also committed to disseminating comprehensive and timely information to its providers through this provider manual regarding Ambetter’s operations, policies, and procedures. Updates to this anual will be posted on our website at
How often does Ambetter recredential?
Ambetter conducts practitioner/provider recredentialing at least every 36 months from the date of the initial credentialing decision or most recent recredentialing decision. The purpose of this process is to identify any changes in the practitioner’s/provider’s licensure, sanctions, certification, competence, or health status which may affect the practitioner’s/provider’s ability to perform services under the contract. This process includes all practitioners, facilities, and ancillary providers previously credentialed and currently participating in the network.
Who must comply with Ambetter Provider Network?
All providers who join the Ambetter Provider Network must also comply with the provisions and guidance set forth by the Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR).
Should practitioners self register with CAQH?
Practitioners/Providers should self-register with CAQH ProView at
Can a provider be credentialed for Ambetter?
If a practitioner/provider already participates with Superior HealthPlanin the Medicaid or a Medicare product, the practitioner/provider will NOT be separately credentialed for the Ambetter product.
