Provider Manuals, Forms and Resources
Reference Materials
- 2020 Provider Manual (PDF)
- Provider Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Balance Billing Quick Reference Guide (PDF)
Credentialing and Update Forms
- Physician Credentialing Application (PDF)
- Facility Credentialing Application (PDF)
- Provider Directory Demographic Survey (PDF)
- Provider Change Form (PDF)
Medical Management
- Prior Authorization Form Inpatient (PDF)
- Prior Authorization Form Outpatient (PDF)
- Formulary Consistency Notice (PDF)
- Prescription Drug Coverage Determination Form (PDF)
- NIA FAQ's (PDF)
- NIA Presentation (PDF)
Quality
- HEDIS Guide (PDF)
- Quality Assessment and Performance Improvement Program Description (PDF)
- How to Access Daily Care Gaps on the Availity Portal (PDF)
- Clinical Practice and Preventive Health Guidelines (PDF)
- 2020 Patient Rewards Program (PDF)
Training
- Secure Portal Authorization Tool Training (PDF)
- 2020 CMS Mandatory Trainings (PDF)
- 2020 Model of Care Provider Training (PDF)
Other
- 2019 Report Card (PDF)
- Caregiver Journal (PDF)
- Opioid Potentiators Memo (PDF)
- Jimmo v. Sebelius Settlement Agreement (PDF)
- Jimmo v. Sebelius Summary of Questions (PDF)
- Secure Portal Account (PDF)
- PaySpan – EFT and ERA Web Based Solution (PDF)
- Provider Claim Dispute Form (PDF)
- CLIA Phase II (PDF)
- New Electronic Prescription Drug Prior Authorization Tool (PDF)