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Forms

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

Appeals and Grievances

Authorizations

Transplant Authorization Request Form

Behavioral Health

If the MCO is requesting concurrent review before the fourth visit; the CFTSS provider can complete this form when requesting continuation of services.

Claims

Refund Check Information Sheet* (RCIS)

Medical Records

Pharmacy

NYS Medicaid Prior Authorization Request Form For Prescriptions

Quality

Other Forms

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.

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Last Updated On: 2/4/2019
Welcome Prescription Drug Plan members! We have important information to share with you about your 2019 plan. Read More. ×
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