Documents & Resources
Please use this section to print forms, access guidelines, and review our business practices. General Information
Provider Notifications
- January, 2012: Effective March 23, 2012, New NDC Billing Requirements
- August, 2010: Letter to Providers (PDF)
Forms & Applications
- CAQH Credentialing Form (PDF)
- Claims Adjustment Form (PDF)
- Credentialing Application Checklist
- EOB Request Form
- Infertility Authorization Form (PDF)
- Member PCP Change Request Form (PDF)
- Notification of Pregnancy Form (PDF)
- Prior Authorization List (PDF)
- Prior Authorization Fax Form (PDF)
- US Script Prescription Prior Authorization Form (PDF)
- Provider Status Change Form (PDF)
- Request for Clinical Information (PDF)
- W9 Form (PDF)
