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Ambetter from MHS is an Exclusive Provider Network Benefit Plan

Fecha: 01/02/17

To our Ambetter from MHS providers:

  • Members enrolled in Ambetter must utilize in-network participating providers and practitioners except in the case of emergency services.
  • When referring a member to another provider or practitioner, please make sure the referral is contracted with Ambetter.
  • If a non-contracted provider or practitioner is utilized, except in the case of emergency services, the member will be responsible for charges that exceed the allowed amount. This could mean hundreds of dollars in out-of-pocket expenses for the member.
  • Contracted providers and practitioners can be identified by visiting our website at ambetter.mhsindiana.com and clicking on “Find a Provider.”

How to Secure Prior Authorization:

  • Use the Pre-Auth Needed Tool at ambetter.mhsindiana.com to quickly determine if a service or procedure requires prior authorization.
  • Submit prior authorization one of the following ways:
    • Secure web portal at provider.mhsindiana.com
    • Phone: Call 1-877-687-1182
    • Fax: Medical 1-855-702-7337 or Behavioral Health 1-855-283-9094

Members must utilize in-network participating providers and practitioners except in the case of emergency services.

Emergency and urgent care services DO NOT require prior authorization. All out-of-network services, providers and practitioners DO require prior authorization.

Failure to complete the required authorization or certification may result in a denied claim.

Thank you for protecting our members from unnecessary out-of-pocket expenses!