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Forms & Resources

Below are important forms and information:

  • Hospice form
  • Medicare Prescription Drug Coverage Determination form
  • 2021 Medicare Part B Step Therapy Preferred Drug list
  • Prior Authorization Form
  • Waiver of Liability Statement
  • Model of Care Training
  • Par Provider Dispute Form
  • Non-Par Provider Appeal Form
  • Getting Started in ConnectCenter
  • Getting Started with Eligibility in ConnectCenter
  • Getting Started with Provider Management in ConnectCenter
  • Getting Started with Claims in ConnectCenter
  • Uploading a Claim in ConnectCenter
  • Keying Professional Claims in ConnectCenter
  • Keying Institutional Claims in ConnectCenter
  • Obtaining a Claim status in ConnectCenter

Instructions on disputing Provider claims online can be found here.

 

 

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