For Providers

These forms are for medical providers only, and not for cast member/employee use.

• Provider Login - Access to claims submitted
• Verification of Benefits

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