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It includes manual revisions, how to use the manual, and sections covering non-discrimination obligations, key contacts, and secure provider portal functionality. 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Insurance Marketplace. ©2025 Celtic Insurance Company.  \n[Ambetter.HomeStateHealth.com](Ambetter.HomeStateHealth.com) 3252242_MO4PMKTMANE  \nPRO_3252242E Internal Approved MMDDYYYY  \nTABLE OF CONTENTS  \nAMBETTER PROVIDER MANUAL REVISIONS---------------------------------------7  \nWELCOME--------------------------------------------------------------------------9  \nHOW TO USE THIS PROVIDER MANUAL------------------------------------------10  \nDental and Vision Provider Manuals----------------------------------------------------------------------------------10  \nAncillary Provider Manuals -------------------------------------------------------------------------------------------10  \nNONDISCRIMINATION OF HEALTH CARE SERVICE DELIVERY--------------------11  \nNewborns and Mothers’ Health Protection Act-----------------------------------------------------------------------11  \nKEY CONTACTS & IMPORTANT PHONE NUMBERS--------------------------------------------------------------------12  \nAMBETTER HEALTH PRODUCTS & NETWORK DESCRIPTIONS-------------------14  \nSECURE PROVIDER PORTAL-------------------------------------------------------16  \nFunctionality-----------------------------------------------------------------------------------------------------------16  \nAvaility Essentials-----------------------------------------------------------------------------------------------------17  \nDisclaimer--------------------------------------------------------------------------------------------------------------17  \nCREDENTIALING & RECREDENTIALING------------------------------------------18  \nEligible Providers------------------------------------------------------------------------------------------------------19  \nNon Registered CAQH Providers--------------------------------------------------------------------------------------19  \nCredentialing Committee---------------------------------------------------------------------------------------------19  \nRecredentialing--------------------------------------------------------------------------------------------------------20  \nPractitioner Right to Review and Correct Information--------------------------------------------------------------20  \nPractitioner Right to Be Informed of Application Status -----------------------------------------------------------20  \nPractitioner Right to Appeal or Reconsideration of Adverse Credentialing Decisions---------------------------21  \nPROVIDER ADMINISTRATION & ROLE OF THE PROVIDER------------------------22  \nProvider Types That May Serve As PCPs------------------------------------------------------------------------------22  \nMember Panel Capacity-----------------------------------------------------------------------------------------------22  \nMember Selection or Assignment of PCP-----------------------------------------------------------------------------23  \nWithdrawing from Caring for a Member -----------------------------------------------------------------------------23  \nPCP Coordination of Care to Specialists -----------------------------------------------------------------------------23  \nP a g e 1 | 263  \n[w w w . a m b e t t e r . h o m e s t a t e h e a l t h . c o m](w w w . a m b e t t e r . h o m e s t a t e h e a l t h . c o m)  \nSpecialist Provider Responsibilities----------------------------------------------------------------------------------24  \nAPPOINTMENT AVAILABILITY & WAIT TIMES------------------------------------25  \nWait Time Standards for All Provider Types-------------------------------------------------------------------------26  \nTravel Distance and Access Standards-------------------------------------------------------------------------------26  \nCOVERING PROVIDERS-----------------------------------------------------------27  \nProvider Phone Call Protocol -----","cbCaiq1qm0Hbnhp2","https://ap.wps.com/l/cbCaiq1qm0Hbnhp2","pdf",4193076,265,"English","# AMBETTER PROVIDER MANUAL REVISIONS\n# WELCOME\n# HOW TO USE THIS PROVIDER MANUAL\n## Dental and Vision Provider Manuals\n## Ancillary Provider Manuals\n# NONDISCRIMINATION OF HEALTH CARE SERVICE DELIVERY\n# KEY CONTACTS & IMPORTANT PHONE NUMBERS\n# AMBETTER HEALTH PRODUCTS & NETWORK DESCRIPTIONS\n# SECURE PROVIDER PORTAL\n## Functionality\n## Availity Essentials\n# CREDENTIALING & RECREDENTIALING\n## Eligible Providers\n## Recredentialing\n# PROVIDER ADMINISTRATION & ROLE OF THE PROVIDER\n# APPOINTMENT AVAILABILITY & WAIT TIMES\n# COVERING PROVIDERS\n# AMBETTER BENEFITS\n# COVERED SERVICES\n# MEMBER BENEFITS, ELIGIBILITY,","[{\"question\":\"What topics are covered in the Ambetter provider manual’s opening sections?\",\"answer\":\"It includes manual revisions, a welcome, and instructions on how to use the manual, including separate guidance for dental/vision and ancillary providers.\"},{\"question\":\"What does the manual address under credentialing and recredentialing?\",\"answer\":\"It covers eligible providers, non-registered CAQH provider handling, the credentialing committee, recredentialing, and practitioner rights related to reviewing and correcting information and appealing adverse decisions.\"},{\"question\":\"How does the manual define provider access and appointment expectations?\",\"answer\":\"It provides wait time standards for provider types, travel distance and access standards, and related responsibilities to ensure timely patient access.\"}]","Provider and Billing Manual - 2025 - Ambetter from Home State Health | PDF",1789798615,93]