Forms and Documents

Forms and Documents

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Provider Manual

2026 Marketplace Provider Manual

Download 2026 Marketplace Provider Manual

2025 Marketplace Provider Manual

Download 2025 Marketplace Provider Manual

Prior Authorization

2026 Prior Authorization Pre-Service Guide and Request Form

Prior Authorization LookUp Tool

Q1 2026 Provider Prior Authorization Code Matrix

Download Q1 2026 Provider Prior Authorization Code Matrix

Authorization/Reauthorization of Residential Substance Use Disorder Treatment Form

Download Authorization/Reauthorization of Residential Substance Use Disorder Treatment Form

Prior Authorization/Medication Exception Request Form

Download Prior Authorization/Medication Exception Request Form

Prior Authorization Specialty Medication Request Form

Download Prior Authorization Specialty Medication Request Form

Prior Authorization Pre-Service Guide Marketplace

Download Prior Authorization Pre-Service Guide Marketplace

Inpatient Rehab, Skilled Nursing Facility, and Long Term Acute Care Request Form

Download Inpatient Rehab, Skilled Nursing Facility, and Long Term Acute Care Request Form

Frequently Used Forms