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Forms

Access key forms for authorizations, claims, pharmacy and more.

Administrative Review

Members can use this form to request a new Primary Care Provider (PCP).

Authorizations

Behavioral Health

A fillable form documenting behavioral health areas of specialization

Since the questionnaire relies on patient self-report, all responses should be verified by the clinician, and a definitive diagnosis is made on clinical grounds taking into account how well the patient understood the questionnaire, as well as other relevant information from the patient.

Georgia Medicaid Behavioral Health Service Request Form: Routine Outpatient Services

Billing Guidelines

Brochures

Claims

Cultural Competency

How To Guides

Member Services

In order to begin the program, members will need to have you complete this form.

Complete this form after the member completes the 6-month Weight Watchers program.

Pharmacy Services

Telemedicine


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Last Updated On: 5/9/2017