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)

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.