Forms and Resources
COMMERCIAL FORMS, TOOLS & RESOURCES
Newsletters
Popular Forms
- Advance Directives
- Authorization to Use or Share Protected Health Information
- Change My PCP
- Common Law Affidavit
- Instructions for Completing the Authorization Form
- Physician Treatment Request Form (Medical Prior Authorization)
- PLEASE NOTE: The prescribing physician will be required to complete the form and submit documentation related to the request.
- Privacy Notice
- Request Member ID Cards
- Transition of Care
Appeals and Grievances Forms
- Appeals and Grievances Procedures
- Appeals and Grievance Request Form - Optional (English) (en Espanol)
- Appointment of Representative Form - Optional (English) (en Espanol)
- External Review Request Form - Required for External Review Only (English) (en Espanol)
Prescription Drug Forms
- Mail Order Form
- Prescription Drug Claim Form
- Prescription Drug Transition of Care
- Specialty Drug Enrollment
For Prescription Drug Prior Authorization and Formulary Exception forms, please click here.
PLEASE NOTE: The prescribing physician will be required to complete the form and submit documentation related to the request.
Informative Documents
- IRS FORM 1095-B
- Care Management and Preauthorization Requirements
- Commercial Subrogation, Third-Party Recovery and Reimbursement
- Clinical Practice Guidelines
- Healthy Living Tips
- Member Rights and Responsibilities
- Notice of Creditable Coverage - 2021
- Preventive Care Guidelines
- Quality Improvement Program
- Request to Limit Use of PHI Form (English) (en Espanol)
- Site of Care
- Verifying a Provider’s Credentials