Access key forms for authorizations, claims, pharmacy and more.
This request will be treated as per the standard organization determination time frames.
Drug Prior Authorization Requests Supplied by the Physician/Facility
A fillable form documenting behavioral health areas of specialization
Contains key phone numbers and information on claims, appeals and more.
Refund Check Information Sheet* (RCIS)
Below are the most commonly prescribed medications that were on the 2018 formulary and their preferred 2019 alternatives.
Fill out and submit this form to request prior authorization (PA) for your Medicare prescriptions.
Fill out and submit this form to request an appeal for Medicare medications.