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Forms: For Providers

 

Provider Resources

 

  • Provider Manual
  • Provider Quick Reference Guide


Forms For Provider Services

  • Provider Demographic Information Change Request Form
  • Provider Recruitment Form

 

Services Requiring Pre-Authorization

  • Ambulatory Surgical Procedures
  • Chiropractic Services(refer to Quick Reference Contact Sheet)
  • Home Care, Certain Outpatient, DME and RX Services
  • Hospital Services

 

Reference Contact Guides

  • Chiropractic Services
  • Hospital Services
  • Outpatient & Home Care Services
  • Prescription Benefit Program

Forms for Authorization

  • Service/Equipment Request for Authorization
  • Home Oxygen Therapy Request for Authorization
  • Prescription Request for Authorization
  • PT/OT/ST Benefit Extension

 

Additional Resources

  • Forms: For Providers
  • Prescription Program
  • Prior Authorization
  • Preferred Durable Medical Equipment Providers
  • Other Services
  • Frequently Asked Questions
    about the Fund's Radiology Program

Submit Your NPI

Using your National Provider Identifier (NPI) simplifies all your Fund transactions, from claims processing to eligibility and referrals.

Do We Have Your National Provider Identifier (NPI)?

  • Submit it now
  • Frequently Asked Questions About the NPI
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