Forms that make doing business with us easier

Whether you need to make a referral, request prior authorization for a treatment or more, filling out the necessary forms will help us respond to your needs quickly and efficiently. Just click on the appropriate form name below to get started.

ERA and EFT enrollment forms have changed.  Enroll by downloading the paper forms or electronically by visiting our Secure Web Portal.  Please contact Provider Relations at 1-800-953-8854 (option 2), then follow the prompts to the Provider Relations department. Or email with any questions or to check enrollment status.

General Provider Forms