Are you looking for Ambetter? Please visit the Ambetter website at https://ambetter.pahealthwellness.com.

We will continue to add resources to this section over the next several months.

• Allwell Provider Manual 2019 (PDF)
• Community HealthChoices Provider Manual (PDF)
• PA Health & Wellness CHC Billing Manual (PDF)
• Provider FAQs (PDF)
• Medicaid Inpatient Authorization Form (PDF)
• Medicaid Outpatient Authorization Form (PDF)
• Medicare Inpatient Authorization Form (PDF)
• Medicare Outpatient Authorization Form (PDF)
• Medication Prior Authorization Form (PDF)
• Obstetrical Needs Assessment Form (PDF)
• General Specialty Medication Prior Authorization Form (PDF) 
• Consent For Provider to File a Complaint or Grievance for Participant Form (PDF) 
• Qualified Medicare Beneficiaries-Billing FAQ (PDF)
• Non-PAR Provider PA (PDF)
• PAR Provider PA (PDF)
• HHAeXchange Electronic Remittance Advice Request Form (PDF)

Behavioral Health Forms

• Medicare Allwell Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
• Medicare Allwell Neuropsychological Testing Authorization Request Form (PDF)
• Medicare Allwell Outpatient Treatment Request Form (PDF)
• Medicare Allwell Psychological Testing Authorization Request Form (PDF)