Utilization Management
- Provider Tips for Authorization Submissions
- UM Prior Authorization Request Form
- Provider Tips for Early Intervention Services (EIS)
- Medicaid Provider Forms
- Applied Behavior Analysis (ABA) Tip Sheet
- Oxygen Request Form
- Behavioral Health Tip Sheet
- Oral/Enteral Nutrition Form
- Cochlear Implant Tip Sheet
- Adult Orthotics and Prosthetics
- Services Requiring Prior Authorization
- Clinical Coverage Determination Criteria
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
- Provider Manual
- Affirmative Statement About Incentives
- Become a Provider
- Medicare Advantage Risk Adjustment Training for Providers
- Notification of Practitioner Rights
- Real Time Eligibility (RTE) Transactions
- CAQH Credentialing
- W-9
- Policy for Selection and Retention of Providers
- 835 and EFT Enrollment Request Form
- Letter to Providers
- Provider Newsletters
- Member Rights & Responsibilities
- DHMP Member Identification Card
Complex Case Management
Health Management
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
- Medicare Waiver of Liability Form