Manuals, Forms and Resources

Arkansas Health & Wellness Manuals & Forms

• Account Manager Secure Portal (PDF)
• PAI Provider Self Reporting Form (PDF)
• Provider Data Change Form (PDF)

Reference Materials

• 2024 Provider and Billing Manual (PDF)
• 2023 Provider and Billing Manual (PDF)
• Quick Reference Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• Provider Portal Initiative FAQ (PDF)
• Envolve Vision Plan Specifics (PDF)
• Ambetter Reimburses for Substance Use Services (PDF)
• Long-Acting Medications as First-Line Treatment in Schizophrenia (PDF)
• Provider Data Change Form (PDF)
• Non-Formulary And Step Therapy Exception Request Form (PDF)
• Opioid Resources for Prescribers
• Ambetter Envolve Eye Exam Incentive Flyer (PDF)
• Wellcare by Allwell Envolve Eye Exam Incentive Flyer (PDF)
• Intro toSober SidekickProvider Training (PDF)

Medical Management/Behavioral Health

• Pre-Auth Needed?Prior Authorization Guide (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Grievance and Appeals Discharge Consultation Form (PDF)
• Turning Point Prior Authorization

Claims and Claim Payment

• Electronic Transactions (PDF)
• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)

Quality

• Practice Guidelines (PDF)
• Cultural Competency Plan (PDF)
• Quality Improvement (QI)
• Ambetter Member Reassignment Form (PDF)
• Providing Quality Care

Provider Credentialing

AttentionIf you would like to become a provider within our network, please fill out the Become a Provider form. Or call us at 1-844-631-6830 or by emailing ArkansasContracting@centene.com.

• Allied and Advance Practice Nurse Credentialing Application (PDF)
• Medical Doctor or Doctor of Osteopathy Credentialing Application (PDF)

To see all coding tip sheets, please visit Coding Tip Sheets and Forms.