Utilization Management
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
- Policy for Selection and Retention of Providers
- W-9
- Letter to Providers
- 835 and EFT Enrollment Request Form
- Member Rights & Responsibilities
- Medicare Waiver of Liability Form
- Provider Newsletters
Complex Case Management
Health Management
Quality Improvement
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