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Forms

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

Appeals and Grievances

Authorizations

Transplant Authorization Request Form

Behavioral Health

Behavioral Health Service Request Form: Applied Behavior Analysis (ABA) For Autism Spectrum Disorder

South Carolina Department of Mental Health CMHC Treatment Review & Authorization Request

Pharmacy

Other Provider Forms

Use this form to request a PCP change for a member.

Refund Check Information Sheet* (RCIS)

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Last Updated On: 5/8/2017
Welcome Prescription Drug Plan members! We have important information to share with you about your 2019 plan. Read More. ×