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-COMM.pdf

Medicare, Providers

Blood Glucose Monitor and Testing Supplies Using the Medical Benefit

PDF icon Blood Glucose Monitor and Testing Supplies_Final_033021.pdf

Members, Providers

Clinical Guideline - Secondary Prevention for Patients with Atherosclerotic Vascular Disease 2023

PDF icon Vascular-Clinical-Guidelines-2023.pdf

Members, Providers

Clinical Guidelines - Diabetes Care 2023

PDF icon 2023-Diabetes-Clinical-Practice-Guideline.pdf

Providers

Colonoscopies Com

PDF icon Colonoscopies-COMM.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

J Code Med Only Update

PDF icon J Code Med only update website 3 30 21.pdf

Providers

J Code Med Only Update 2022

PDF icon J-Code-Med-only-update-website-04-22.pdf

Providers

Long Term Acute Care Hospitalization Com

PDF icon Long-Term-Acute-Care-Hospitalization-COMM.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-COMM.pdf

Providers

Magnetic Resonance Imaging (MRI) Lumbar Spine Com

PDF icon MRI-Lumbar-Spine-Criteria-Outpatient-COMM.pdf

Members, Providers

Medical Services That Require Prior Auth

PDF icon MEDICAL-SERVICES-THAT-REQUIRE-PRIOR-AUTHORIZATION-1-31-23.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 33021.pdf

Providers

Pediatric Health Assessment

PDF icon Pediatric Health Assessment.pdf

Providers

Pediatric Health Assessment 2022

PDF icon Pediatric-Health-Assessment-2022-FINAL.pdf

Providers

Perinatal Care

PDF icon Perinatal Care.pdf

Providers

Residential Eating Disorders Treatment Com

PDF icon Residential-Eating-Disorders-Treatment-COMM.pdf

Providers

Residential Substance Abuse Treatment Com

PDF icon Residential-Substance-Abuse-Treatment-COMM.pdf