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

Administrative Review


Ohana Oral Nutrition Request Form

Requests for prior authorization (with supporting clinical information and documentation) should be sent to  ĽOhana 14 days prior to the date the requested services will be performed.

Behavioral Health


Refund Check Information Sheet* (RCIS)

Medical Records


This form is used to determine coverage for prior authorizations and medications with utilization management rules.

This form is a prior authorization request for injectable infusions.

Other Provider Forms

Please use this form to refer a member to the Service Coordination / Disease Management Department


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Last Updated On: 5/9/2017