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.
 

Practice Forms

Billing Information Form - Use this form for practice demographic changes. 
Claims Reconsideration Form   •   Billing Corrected Claims Information Sheet 
Electronic Funds Transfer (EFT) Authorization Agreement
Provider Credentialing and Change Form - Use this form for contracted provider adds, changes, and terms.
Notification/Prior Approval Form

Prescription Prior Approval Form 
Prior Approval Overview & Notification (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)

* 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
Health and Wellness Information
HEDIS Measurement Definitions
ICD-10 Readiness
Quick Reference Guide for Providers
Value Based Insurance Design (VBID) Overview