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Forms

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

Appeals & Grievances

Authorizations

Behavioral Health Forms

Claims

Refund Check Information Sheet* (RCIS)

Medical Records

Pharmacy

This list includes the most commonly prescribed medications that were on the 2016 formulary and their preferred 2017 alternatives.

Fill out and submit this form to request prior authorization (PA) for your Medicare prescriptions.

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: 5/17/2018
Based on a recent legal decision, changes to Medicaid under Kentucky HEALTH will not begin on July 1, 2018 as planned. Read more. Important Update about Kentucky HEALTH ×