Documents & Forms Center

Medicare, Providers

Anesthesia and Facility Charges for Dental Services MCR

PDF icon Anesthesia and Facility MCR.pdf

Providers

Applied Behavioral Analysis (ABA) Services Com

PDF icon Applied Behavior Analysis (ABA) Services.pdf

Medicare, Providers

Blood Glucose Monitor and Testing Supplies Using the Medical Benefit

PDF icon Blood-Glucose-Monitor-and-Testing-Supplies_Final_120419-002.pdf

Members, Providers

Clinical Guideline - Secondary Prevention for Patients with Atherosclerotic Vascular Disease

PDF icon Vascular Clinical Guidelines 2019.pdf

Members, Providers

Clinical Guidelines - Diabetes Care

PDF icon 2019 Diabetes Clinical Practice Guideline 3.12.19.pdf

Providers

Colonoscopies Com

PDF icon Colonoscopies_COM.pdf

Agents, Employers, Members, Providers

Glossary of Health Coverage and Medical Terms

PDF icon Glossary of Health Coverage and Medical Terms.pdf

Agents, Employers, Medicare, Members, Providers

Health and Fitness Reimbursement Form

PDF icon Fitness Reimbursement Form 040820 FILLABLE.pdf

Medicare, Providers

Implantable Hearing Devices MCR

PDF icon Implantable Hearing Devices MCR.pdf

Providers

Instructions for completing Prior Authorization Form

PDF icon Instructions for completing Prior Authorization Form.pdf

Providers

Long Term Acute Care Hospitalization Com

PDF icon Long Term Acute Care Hospitalization Com.pdf

Medicare, Providers

Long Term Acute Care Hospitalization MCR

PDF icon Long Term Acute Care Hospitalization MCR.pdf

Providers

Magnetic Resonance Imaging (MRI) Cervical Spine Com

PDF icon MRI Cervical Spine Criteria Outpatient Com.pdf

Providers

Magnetic Resonance Imaging (MRI) Lumbar Spine Com

PDF icon MRI Lumbar Spine Criteria Outpatient Com.pdf

Providers

Medications Obtained Through the Medical Benefit

PDF icon j-code-med-only-update-website-12-18-18.pdf

Providers

Patient Headache Diary

PDF icon mms-headache-diary-8-2018.pdf

Providers

Pediatric Health Assessment

PDF icon Pediatric Health Assessment.pdf

Providers

Perinatal Care

PDF icon Perinatal Care.pdf

Providers

Residential Eating Disorders Treatment Com

PDF icon Residential Eating Disorders Treatment Com.pdf

Providers

Residential Substance Abuse Treatment Com

PDF icon Residential Substance Abuse Treatment Com.pdf

Providers

Skilled Nursing Facilities Com

PDF icon Skilled Nursing Facilities Com.pdf

Medicare, Providers

Skilled Nursing Facilities MCR

PDF icon Skilled Nursing Facilities MCR.pdf

Providers

Sleep Studies Com

PDF icon Sleep Studies Com.pdf

Providers

Thoracic Outlet Syndrome Com

PDF icon Thoracic Outlet Syndrome Com.pdf