Coordinated Care HealthEducational Material, Resources & Forms
Login for More Information
You will be able to view things like:
- Member benefits and eligibility
- Submit claims & review payment history
- The PCP panel (patient list)
- Member gaps in care
- And more!
-
You will need Adobe Reader to open PDFs on this site.
Download the free version of Reader
Manuals and Guides
Provider Manual
Provider Billing Manual
Provider Quick Reference Guide
Provider Prior Authorization Quick Reference Guide
Quick Reference Drug List
Claims Billing Cheat Sheet
Claims FAQ Sheet
PT, OT and ST Medical Necessity Criteria
Perinatal Depression Screening Program Policy
Specialty Therapy and Rehab Services Policy
Forms
Prior Authorization Form – Inpatient
Prior Authorization Form – Outpatient
Outpatient Treatment Request Form – Specialty Therapy and Rehab Services
Outpatient Treatment Request Form – Behavioral Health
Provider Notification of Pregnancy Form
Prenatal Vitamin Program
Ophthalmology Pre-Authorization Request Form
MemberConnections Referral Form
Appeal Form for Member Authorized Representative
Claim Dispute Form
Provider Demographic Change Form
Provider DME Request Form
Provider Request for Breast Pump Form for Nursing Mother
Outpatient Psychological Testing Form
General
MemberConnections Provider Brochure
HEDIS Guide
Transplant Check List
Partnership Access Line
Provider Newsletters – Winter Edition 2013
2012 Cultural Competency Plan – Cenpatico for Behavioral Health
National
Policies and Procedures
Providers can request Provider Policies and Procedures by contacting our Provider Services Department at 1-877-644-4613 and a representative will assist you.
