For your convenience, our most commonly used physician and provider forms are available below. Just click on the applicable form, print, complete and submit to the address indicated on the form.

These documents are provided in the Adobe Acrobat PDF format for which you will need the Acrobat Reader program or plug-in. If you don't already have Acrobat Reader, you can download it free by clicking this button.


    1. How to Become a Health Plan Select Participating Provider
    2. Allied Credentialing Checklist
    3. Ancillary Provider Application
    4. Ancillary Credentialing Checklist
    5. Practitioner Credentialing and Re-credentialing Checklist
    6. Credentialing Application Form
    7. AAHPS Fee Schedule Request Procedure
    8. Provider Manual

Prior Authorization Forms

    1. Medical Servivces Prior Authorization Form
    2. Androgenic Agents
    3. Caremark Enrollment Form
    4. LYRICA (pegabalin)
    5. Non-Sedating Antihistamines
    6. PROVIGIL (modafinil)
    7. Step Therapy Drugs
    8. TOPAMAX (topiramate)
    9. Atypical Antipsychotics
 
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