Coworker / Participant Login
Find a Provider
Manage My Benefits
Find Forms
Submit a Claim
Contact Us
Find a Provider
Manage My Benefits
Find Forms
Submit a Claim
Contact Us
Health Plan Forms
Accident Questionnaire
Authorization to Release Confidential Health Claim
Alternate Payee Request Form
Coordination of Benefits Questionnaire
Dependent Disability Form
Pharmacy Reimbursement/Claim Form
Submit a Claim
Request an ID Card
Continuity of Care
Pre-Treatment Forms
Inpatient Admission Prior Authorization Request
Standard Outpatient Prior Authorization Request
Bariatric Surgery Prior Authorization Request
Cancer Prior Authorization Request
Dialysis Prior Authorization Request
DME Prior Authorization Request
Home Delivery Medical Supplies
Home Health Prior Authorization Request
Infusion Services Prior Authorization Request
Ongoing Therapy Prior Authorization Request
Organ and Tissue Prior Authorization Request
Spinal Surgery Prior Authorization Request
© 2024 Allegiance Benefit Plan Management, Inc. All Rights Reserved.
Are you still there?
Due to inactivity, you will be logged out in