Here are some of the common documents and forms you may need in order to treat our members and do business with us.
Provider Administration Manual (PAM)
Clinical Practice Guidelines
Predetermination Authorization Request
Durable Medical Equipment (DME) Authorization Request
Inpatient/Outpatient Services Authorization Request
Provider Appeal Form
Provider Reconsideration Form
2022 Prescription Drug List (Formulary)
Provider-Administered Specialty Pharmacy Products
2022 Part D Prior Authorization Criteria
Step Therapy Guide
Provider Data Change Form
Provider Reimbursement Quick Reference Guide
Quality Program Information
Diabetes Prevention Program (DPP) Referral Form
Whether you have questions about joining our network, contracts or Availity, we can help.