Documents & Forms Center

Members, Providers

2018 Guidelines - Assessment and Treatment of Children with ADHD

PDF icon ADHD GUIDELINES 5.8.18_Final.pdf

Members, Providers

2018 Guidelines - Diabetes Care

PDF icon 2018 Diabetes Clinical Practice Guideline 3.6.18.pdf

Members, Providers

2018 Guidelines - Management of High Blood Pressure in Adults

PDF icon Management of High Blood Pressure in Adults 5 8 18 Final.pdf

Members, Providers

2018 Guidelines - Management of Major Depression in Primary Care

PDF icon Depression Clinical Practice Guidelines 2017 FINAL.PDF

Members, Providers

2018 Guidelines - Pediatric Health Assessment

PDF icon Ped Health Assessment 5-8-2018_Final.pdf

Members, Providers

2018 Guidelines - Perinatal Care

PDF icon Perinatal Care QIC approved 5-8-2018_Final.pdf

Members, Providers

2018 Guidelines - Secondary Prevention for Patients with Atherosclerotic Vascular Disease

PDF icon Secondary Prevention for Patients with Atherosclerotic Vascular Disease.pdf

Medicare, Providers

Anesthesia and Facility Charges for Dental Services MCR

PDF icon Anesthesia and Facility MCR 8-18.pdf

Providers

Applied Behavioral Analysis (ABA) Services Com

PDF icon Applied Behavior Analysis (ABA) Services.pdf

Providers

Blood Glucose Monitor and Testing Supplies Using the Medical Benefit

PDF icon blood-glucose-monitor-and-testing-supplies_final_121818.pdf

Providers

Colonoscopies Com

PDF icon Colonoscopies- Com 8-18.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 012819 FILLABLE.pdf

Medicare, Providers

Implantable Hearing Devices MCR

PDF icon Implantable Hearing Devices MCR 8-18_0.pdf

Providers

Instructions for completing Prior Authorization Form

PDF icon Instructions for completing Prior Authorization Form.pdf

Providers

J Code Med only update 04 30 19

PDF icon j_code_med_only_update04_30_2019.pdf

Providers

Long Term Acute Care Hospitalization Com

PDF icon Long Term Acute Care Hospitalization Com 8-18.pdf

Medicare, Providers

Long Term Acute Care Hospitalization MCR

PDF icon Long Term Acute Care Hospitalization MCR 8-18_0.pdf

Providers

Magnetic Resonance Imaging (MRI) Cervical Spine Com

PDF icon MRI_Cervical_Spine_Criteria_Outpatient_Com_8-18.pdf

Providers

Magnetic Resonance Imaging (MRI) Lumbar Spine Com

PDF icon MRI Lumbar Spine Criteria Outpatient Com 8-18.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

Residential Eating Disorders Treatment Com

PDF icon Residential Eating Disorders Treatment Com 5-18.pdf

Providers

Residential Substance Abuse Treatment Com

PDF icon Residential Substance Abuse Treatment Com 10-18.pdf