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Utilization Management

• Home Health Tips for Providers
• Oxygen Request Form
• Services Requiring Prior Authorization
• Oral/Enteral Nutrition Form
• UM Prior Authorization Request Form
• Adult Orthotics and Prosthetics
• Medicaid Provider Forms

Pharmacy

• Pharmacy Prior Auth Request (PAR)/Exception Request Form
• Pharmacy Prior Authorization Request Form
• Medicare Prescription Drug Coverage Determination Request Form
• Upload a Pharmacy Prior Authorization Form Here
• Commercial Prior Authorization Criteria
• Medicaid / CHP+ Prior Authorization Criteria
• Commercial Step Therapy
• Medicaid / CHP+ Step Therapy
• Medicare Prior Authorization Criteria
• Elevate Prior Authorization Criteria
• Medicare Step Therapy

Provider Relations & Credentialing

• Become a Provider
• Affirmative Statement About Incentives
• Notification of Practitioner Rights
• Medicare Advantage Risk Adjustment Training for Providers
• CAQH Credentialing
• Real Time Eligibility (RTE) Transactions
• Letter to Providers
• W-9
• Member Rights & Responsibilities
• 835 and EFT Enrollment Request Form
• Provider Newsletters
• Medicare Waiver of Liability Form

Complex Case Management

• Medical Management Referral Form

Health Management

• Model of Care

Quality Improvement

• EPSDT
• HCPF EPSDT Training
• AAP Bright Futures

Claims

• Billing Information
• Reason Codes

Grievances And Appeals

• CHP+ Grievances and Appeals
• Designated Personal Representative (DPR) Form
• Medicaid Grievances and Appeals
• CHP+ Complaint and Appeal Form
• Medicare Exceptions Grievances and Appeals
• Commercial Products Complaint and Appeal Form
• Provider Request for Dispute Resolution Form
• Medicaid Complaint and Appeal Form
• Provider Request for Payment Reconsideration Form
• Medicare Complaint and Appeal Form
• Provider Reconsideration and Dispute FAQs