Reference Materials

• 2020 Provider and Billing Manual (PDF)
• 2021 Provider and Billing Manual (PDF)
  
• Quick Reference Guide (PDF)
• Prior Authorization Guide (PDF)
• Payspan (PDF)
• Secure Portal (PDF)
• ICD-10 Information
• Referral Notice for Providers

Behavioral Health

• Outpatient Treatment Request Form (PDF)
• OTR Completion Tip Sheet (PDF)
• Discharge Consultation Form (PDF)
• Electroconvulsive Therapy Authorization Request Form (PDF)
• Intensive Outpatient/Day Treatment Form Mental Health/Chemical Dependency (PDF)
• Psychological or Neuropsych Testing Authorization Request Form (PDF)

Medical Management

• Pre-Auth Needed?
• Prior Authorization Quick Reference Guide (PDF)
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Grievance and Appeals

Claims

• Claim Dispute Form (PDF)

Quality

• Practice Guidelines (PDF)
• 2016 HEDIS Quick Reference Guide (PDF)
• Quality Improvement (QI)