For your convenience, we have compiled the most frequently used documents in one location. This collection of files and forms is available to you from our health plans. Here you will find provider manuals, formularies, pre-certification requirements, and other supporting documentation to help you provide superior service to our members. If you wish, you may view, print, or store these files below for your future reference.
Provider Document Library
- Flu Shot Reminder 2016
- Who is my Provider Relations Representative?
- Click here to view the Letter Regarding Member Status, Incarcerated, Warning and Address Mismatch
- Provider Relations Quick Reference Guide
2016 Provider Forums
Thanks to all of you for attending our forums. We appreciate your feedback and want you to know we are working to make improvements!
- Address Demographic TIN Change Form
- Case Management Referral Form
- Claim Reconsideration Form
- ERA form
- EFT form
- Member Authorization Release for Standard Appeal
- PCP Change Form
- Prenatal Notification Form
- Provider portal instructions
- Provider portal registration
- Provider Authorization Fax Form
- Provider Information Form
- ECT and TMS Request Form
- Psychological Testing Request Form
- Neuropsychological Test Request Form
- Outpatient Treatment Request (OTR) Form