Utilization Management

• UM Prior Authorization Request Form
• Oxygen Request Form
• Request to Withdraw Services Form
• Medical Prior Authorization List

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

Complex Case Management

• Medical Management Referral Form

Health Management

• Model of Care

Quality Improvement

• EPSDT
• AAP Bright Futures

Claims

• Reason Codes

Grievances And Appeals

• Medicaid Grievances & Appeals
• CHP+ Complaint and Appeal Form
• Medicare Exceptions Grievances and Appeals
• Commercial Products Complaint and Appeal Form
• Designated Personal Representative (DPR) Form
• Medicaid Complaint and Appeal Form
• Provider Dispute Resolution Form
• Medicare Complaint and Appeal Form