- Home
- Provider
- Provider Resources
- Commercial Resources
Provider Resources
Commercial Resources
Commercial Resources
Authorization/Pre-Certification Forms
-
Imaging Request Form
-
Referral Authorization Form
-
DME Form
-
Inpatient/Outpatient Precertification Form
-
Rehabilitation Precertification Forms
-
SNF/Rehab Discharge Documentation
-
Provider Reference Guide
-
Policy for Mechanical Stretching Devices
-
Policy for Proton Beam Radiotherapy
Behavioral Health
-
Psychological-Neurological Testing Request Form
-
Transcranial Magnetic Stimulation Authorization Request Form
-
Electroconvulsive Therapy (ECT) Authorization Request Form
-
Mental Health Continued Stay Review Fax Form
-
Substance Abuse Initial Review Fax Form
-
Substance Abuse Continued Stay Review Form
-
Discharge Orders Fax Form
-
Applied Behavior Analysis (ABA) Initial Authorization Request Form
-
Applied Behavior Analysis (ABA) Concurrent Authorization Request Form
Pharmacy
-
Medical Benefit Drug Prior Authorization Form
-
Commercial Pharmacy Coverage Determination Form
-
General Commercial Formulary
-
2024 Diagnosis Code Guide
-
Medical Drug Policies
-
HelpScript FAQ
-
National Comprehensive Cancer Network
-
Medical Preferred Drug Program
Other
-
Provider Compliance Training
-
InterQual Transparency Tool
-
Therapy Precertification Form
-
EFT - Electronic Payment Flyer