Provider materials and forms

• Provider manual (PDF)
• Provider Manual Regulatory Compliance Addendum (PDF)
• Provider Manual Regulatory Compliance Addendum (PDF)
• Provider quick reference guide (PDF)
• COVID-19 Billing Reference Guide - Updated May 27, 2021 (PDF)
• Remit – How to Read (PDF)
• Virginia FAQ for PRSS and Cures Act Compliance (PDF)
• Member Benefits Quick Sheet for Providers (PDF)
• Hepatitis B Vaccine Tip Sheet for Providers (PDF)
• CPT II Category Codes Closing Gaps in Care (PDF)
• Guide to Submit Claims Electronically with Office Ally Clearinghouse (PDF)
• Echo Health electronic payment system guide (PDF)
• Availity - Coding and Condition Gaps Instructions (PDF)
• Quick pay program (PDF)

• Early Intervention Provider Resources (PDF)
• Recording Newborn Name on the E213 (PDF)
• Brain Injury Services Targeted Case Management - A Guide for Providers (PDF)
• Doula Provider Manual (PDF)
• EVV Provider Resource Guide for Agencies (PDF)
• EVV Provider Resource Guide for Facilities (PDF)
• Tobacco Use Cessation in Pregnant Women - Reimbursement for Screening Pregnant Women (PDF)
• Applied Behavioral Analysis (PDF)

Shared decision-making aids are communication tools that can help providers and their patients make informed health care decisions based on what is important to their patients. They do not replace physician guidance; they are intended to help complement discussions between patients and providers on treatment decisions.

Below are evidence-based aids that provide information about treatment options, lifestyle changes, and outcomes.

• American Heart Association | Health Topics
• Diabetes | American Heart Association
• Flu Prevention | American Heart Association
• Heart Facts | American Heart Association
• Mayo Clinic | Care that fits
• Statin Choice | Mayo Clinic
• Depression Medication Choice | Mayo Clinic
• Cardiovascular Primary Prevention Choice | Mayo Clinic

• EFT ERA Registration Services (PDF)
• Provider dispute and resubmission form (PDF)
• Behavioral health/community mental health rehabilitation services (CMHRS) expansion forms
• Critical incident report form (PDF)
• Managed care organization (MCO) authorization processes form (PDF)

• Prior Authorization Request Form (PDF)
• Addiction and recovery treatment services (ARTS) authorization and registration forms
• Community Mental Health Rehabilitative Services (CMHRS) and BRAVO authorization and registration forms

• Prenatal risk assessment form (PDF)
• Provider notification: Eviti Connect for oncology patients (PDF)