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. Credentialing FAQ
    2. Practitioner Credentialing and Re-credentialing Checklist
    3. AAHPS Fee Schedule Request Procedure
    4. Provider Manual

Prior Authorization Forms

    1. Medical Services Prior Authorization Form
    2. Androgenic Agents
    3. Caremark Enrollment Form
    4. DME Request Form
    5. LYRICA (pegabalin)
    6. Non-Sedating Antihistamines
    7. PROVIGIL (modafinil)
    8. Reclast (zoledronic acid) Injection
    9. Step Therapy Drugs
    10. TOPAMAX (topiramate)
    11. Atypical Antipsychotics
    12. Accutane Prior Authorization Form
    13. Actiq Prior Authorization Form
 
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