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The orientation states that eligible cost-share assistance is paid directly from the government to the member’s health plan.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},302925,1789798627,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,113,118,123],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":110,"show_sort_weight":111,"slug":112},17,"Forms",40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":4,"slug":125},158,"general-158",{"code":4,"msg":81,"data":127},{"doc_id":78,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":124,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":135,"language":136,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":12,"update_tm":79,"read_time":140},24189269381491,"https://ap-avatar.wpscdn.com/avatar/160000cf11732dd8392?x-image-process=image/resize,m_fixed,w_180,h_180&k=1788146458752108895","WELCOME TO  \nAmbetter from Arkansas  \nHealth & Wellness  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 1  \nAgenda  \nOverview  \n❑ Who We Are  \n❑ Affordable Care Act  \n❑ The Health Insurance Marketplace What You Need To Know  \n❑ Key Contact Information  \n❑ Provider Toolkit and Manual  \n❑ Provider Relations  \n❑ Public Website and Secure Portal  \n❑ Verification of Eligibility, Benefits, and Cost Shares  \n❑ Specialty Referrals  \n❑ Prior Authorization  \n❑ Claims, Billing, and Payments  \n❑ Complaints, Grievances, and Appeals  \n❑ Specialty Companies and Vendors Risk Adjustment  \nQ & A  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 2  \nWho We Are  \n❑Ambetter from Arkansas Health & Wellness provides market-leading, affordable health insurance on the Health Insurance Marketplace.  \n\\#1 carrier  \non the health insurance marketplace  \n4M+  \nmembers insured across the country  \n❑We are certified as a Qualified Health Plan issuer.  \n❑Ambetter delivers high quality, locally based healthcare services to its members, with our providers benefiting from enhanced collaboration and strategic care coordination programs.  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 3  \nThe Affordable Care Act  \nKey objectives of the Affordable Care Act (ACA):  \n• Increase access to quality health insurance  \n• Improve affordability  \nAdditional parameters:  \n• Dependent coverage to age 26  \n• Pre-existing condition insurance plan (high-risk pools)  \n• No lifetime maximum benefits  \n• Preventative care covered at 100%  \n• Insurer minimum loss ratio (80% for individual coverage)  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 4  \nThe Affordable Care Act   \nReform the commercial insurance market—Marketplace or Exchanges  \n• No more underwriting—guaranteed issue  \n• Minimum standards for coverage: Benefits and cost sharing limits  \n• Subsidies for lower incomes (100–138% FPL)—Effective only for the Arkansas market  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 5  \nHealth Insurance Marketplace   \nSubsidies come in the form of:  \n• Advanced Premium Tax Credits (APTC)  \n• Cost Share Reductions (CSR)  \nAll benefit plans have cost shares in the form of copays, coinsurance, and deductibles  \n• Some members will qualify for assistance with their cost shares based on their income level.  \n• This assistance would be paid directly from the government to the member’s health plan.  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 6  \nHealth Insurance Marketplace   \nOnline Marketplace for purchasing health insurance  \nPotential members can:  \n•Register  \n•Determine eligibility for all health insurance programs  \n•Shop for plans  \n•Enroll in a plan  \n•Exchanges may be state-based, federally facilitated, or state partnership—Arkansas is a stated-based and federally facilitated Marketplace.  \nThe Health Insurance Marketplace is the only way to  \npurchase insurance AND receive subsidies.  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 7  \nWHAT YOU NEED TO KNOW  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 8  \nKey Contact Information   \nAmbetter from Arkansas Health & Wellness  \nPhone:  \n1-877-617-0390  \n(TTY: 1-877-617-0392)  \nWeb:  \n[AmbetterHealth.com](AmbetterHealth.com)  \nSecure Provider Portal:  \n[Provider.ARHealthWellness.com](Provider.ARHealthWellness.com)  \nGetting Acquainted  \nAfter you have completed the credentialing process, you will receive a provider toolkit. Our toolkit contains useful information for getting started as an Ambetter provider.  \nYour toolkit will contain helpful information, such as:  \n• Welcome Letter  \n• Ambetter Provider Introductory Brochure  \n• Secure Portal Setup  \n• Electronic Funds Transfer Setup  \n• Prior Authorization Guide  \n• Quick Reference Guide  \n• Provider Office Window Decal  \nConfidential and Proprietary Information. AHW25-H-009 2/21/2025 10","cbCaihsy2hRMxnMn","https://ap.wps.com/l/cbCaihsy2hRMxnMn","pdf",9133414,57,"English","# Agenda\n## Who We Are\n## The Affordable Care Act\n## Health Insurance Marketplace\n## What You Need To Know\n## Key Contact Information\n## Getting Acquainted","[{\"question\":\"What topics are included in the Ambetter new provider orientation agenda?\",\"answer\":\"The agenda covers Who We Are, the Affordable Care Act, the Health Insurance Marketplace, key contact information, the provider toolkit and manual, provider relations, verification of eligibility and cost shares, specialty referrals, prior authorization, claims/billing/payments, complaints and appeals, and related vendors or risk adjustment.\"},{\"question\":\"What are the key objectives of the Affordable Care Act (ACA) referenced in this orientation?\",\"answer\":\"The orientation lists objectives to increase access to quality health insurance and improve affordability, along with parameters such as dependent coverage to age 26, no lifetime maximum benefits, and preventative care covered at 100%.\"},{\"question\":\"How do members receive subsidies in the Health Insurance Marketplace?\",\"answer\":\"Subsidies are described as Advanced Premium Tax Credits (APTC) and Cost Share Reductions (CSR). The orientation states that eligible cost-share assistance is paid directly from the government to the member’s health plan.\"}]","Ambetter from Arkansas Health & Wellness - New Provider Orientation - Agenda | PDF",20]