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FAQ
2025 Marketplace Provider Manual
2024 Marketplace Provider Manual
Prior Authorization LookUp Tool
Prior Authorization 2025 Guide
Prior Authorization 2024 Guide
Provider Dispute Resolution Request Form
No Surprises Act - Independent Dispute Resolution Form (Non-Contracted Providers only)
Prescription Drug Prior Authorization Request Form
Medical Benefit (HCPCS/J-Code) Drug Prior Authorization Form
Certificate of Medical Necessity-Enteral Nutrition
Provider Information Data Form
Member Grievance Form (English)
Member Grievance Form (Spanish)
Allowed In-Office Lab Test List, effective 5-15-2018
Health Education Referral Form
Health Management Services Flyer in English (for Members only)
Health Management Services Flyer in Spanish (for Members only)
Health Management Services Flyer in Arabic (for Members only)
Health Management Services Flyer in Vietnamese (for Members only)
Health Education Services Provider Resources Flyer (for Providers only)
Behavioral Health Prior Authorization Form
Behavioral Health Therapy Prior Authorization Form (Autism)
Complex Case Management – External CM Referral Form
MCG Cite AutoAuth Provider Access Quick Resource Guide
AB 2352 Prescription Drug Cost Estimator Guide