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

Appeals & Grievances


Behavioral Health Forms

Behavioral Health Areas of Specialization

A fillable form documenting behavioral health areas of specialization

Helpful Documents

Contains key phone numbers and information on claims, appeals and more.


Refund Check Information Sheet* (RCIS)

Medical Records


Drug Prior Authorization Requests Supplied by the Physician/Facility

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.

Other Provider Forms


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Last Updated On: 12/3/2020