Provider Forms

Download W-9 Form
Download a standard W-9 Form.

Precertification Form
(Standard Precert Form). This form is for use in the precertification of plan services as defined by the plan document.

Claim Submission Instructions
(Providers will receive these instructions when they request a faxback verification. This information will compliment the instructions for claim submission on the participant’s ID Card, which includes the electronic submission payor id number.

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