Utilization Management
- Provider Tips for Authorization Submissions
- Provider Tips for Early Intervention Services (EIS)
- Provider Tips for Home Health Care
- Applied Behavior Analysis (ABA) Tip Sheet
- Behavioral Health Tip Sheet
- Cochlear Implant Tip Sheet
- Medicaid Provider Forms
- Oxygen Request Form
- Oral/Enteral Nutrition Form
- Adult Orthotics and Prosthetics Form
- Clinical Coverage Determination Criteria
Pharmacy
- Upload a Pharmacy Prior Authorization Form Here
- Medicare Prescription Drug Coverage Determination Request Form
- Commercial Prior Authorization Criteria
- Commercial Step Therapy
- Medicare Prior Authorization Criteria
- Medicare Step Therapy
- Medicaid / CHP+ Prior Authorization Criteria
- Medicaid / CHP+ Step Therapy
- Elevate Prior Authorization Criteria
Provider Relations & Credentialing
- Notification of Practitioner Rights
- CAQH Credentialing
- Policy for Selection and Retention of Providers
- Letter to Providers
- Member Rights & Responsibilities
- Affirmative Statement About Incentives
- Medicare Advantage Risk Adjustment Training for Providers
- Real Time Eligibility (RTE) Transactions
- W-9
- 835 and EFT Enrollment Request Form
- Provider Newsletters
- DHMP Member Identification Card
Grievances And Appeals
- CHP+ Grievances and Appeals
- Medicaid Grievances and Appeals
- Medicare Exceptions Grievances and Appeals
- Provider Request for Dispute Resolution Form
- Designated Personal Representative (DPR) Form
- CHP+ Complaint and Appeal Form
- Commercial Products Complaint and Appeal Form
- Medicaid Complaint and Appeal Form
- Medicare Complaint and Appeal Form
- Medicare Waiver of Liability Form