Professional Documents and Forms

The links below provide access to commonly used forms and other helpful reference materials.  Please note that these resources are for professionals currently contracted with Community Health Options®.

If you are not currently contracted with us and would like to be, please contact:

       Medical providers: Contracting@HealthOptions.org

       Behavioral health providers:  Behavioral Healthcare Program at 800.538.9698.

Important Provider Update regarding Critical Program Date Change

The eviCore Prior Approval go live date has been moved to December 22, 2017. For more information, please click here

 

Practice Forms

Billing Information Form - Use this form for practice demographic changes. 
Claims Reconsideration Form   •   Billing Corrected Claims Information Sheet 
Electronic Fund Transfer (EFT) & Electronic Remittance Advice (ERA) Authorization Agreement (effective 1.1.18)
Provider Credentialing and Change Form - Use this form for contracted provider adds, changes, and terms.
Prescription Prior Approval Form 
Effective 6/1/17
Prior Approval Overview & Notification (effective 6/1/17)
Notification/Prior Approval Form (effective 6/1/17)
Medical Prior Approval & Notification Requirements - Quick Reference Guide (effective 6/1/17)
Durable Medical Equipment Prior Approval Requirements - Quick Reference Guide (effective 6/1/17)
Behavioral Health Prior Approval & Notification Requirements - Quick Reference Guide (effective 6/1/17)
Medications Prior Approval & Notification Requirements - Quick Reference Guide (effective 6/1/17)
Effective 1/1/18
Prior Approval Overview & Notification (effective 1/1/18)
Notification/Prior Approval Form (effective 1/1/18) 
Medical Prior Approval & Notification Requirements - Quick Reference Guide (effective 1/1/18)
Durable Medical Equipment Prior Approval Requirements - Quick Reference Guide (effective 1/1/18)
Behavioral Health Prior Approval & Notification Requirements - Quick Reference Guide (effective 1/1/18)
Medications Prior Approval & Notification Requirements - Quick Reference Guide (effective 1/1/18)
Summary of Authorization Requirement Updates - Quick Reference Guide (effective 1/1/18)
eviCore Medical Prior Approval Requirements - Quick Reference Guide (effective 1/1/18)
Guidelines for Treatment of General Anxiety Disorder in Adults in Primary Care (effective 1/1/18)

* For web portal access, please contact us at provider@healthoptions.org.


General Information

Rx Savings Solutions - FAQs for Providers
Chronic Illness Support Program
Grace Period Notifications
Risk Adjustment: Key Points for Providers
HEDIS Measurement Definitions
ICD-10 Readiness
Quick Reference Guide for Providers
Value Based Insurance Design (VBID) Overview
 

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