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