Forms & Resources
Below are important forms and information:
- Joint Electronic Funds Transfer and Electronic Remittance Advice Signup
- Hospice form
- Provider Pharmacy Coverage Determination Form
- Prior Authorization List
- Prior Authorization Form
- Waiver of Liability Statement
- Model of Care Training
- Par Provider Dispute Form
- Non-Par Provider Appeal Form
- Getting Started in ConnectCenter
- Getting Started with Eligibility in ConnectCenter
- Getting Started with Provider Management in ConnectCenter
- Getting Started with Claims in ConnectCenter
- Uploading a Claim in ConnectCenter
- Keying Professional Claims in ConnectCenter
- Keying Institutional Claims in ConnectCenter
- Obtaining a Claim status in ConnectCenter
Instructions on disputing Provider claims online can be found here.