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  2. Forms and Reference Material
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  3. Provider Manual and Newsletters
  4. Forms and Reference Material

Forms and Reference Material

Forms and Reference Material
picture_as_pdf2024-2025 Anti-Fraud Plan
picture_as_pdf2025 FWA Audit Plan - Supplemental Guide
Centers for Medicare and Medicaid Services - Fraud and Abuse
picture_as_pdfClinical Practice Guidelines
picture_as_pdfCreate Your Highmark Health Options NaviNet Account
picture_as_pdfCultural Competency Data Form
picture_as_pdfEPSDT Member Outreach Form
picture_as_pdfFraud and Abuse Laws and Regulations
picture_as_pdfGold Card Program FAQs
picture_as_pdfGuidingCare User Guide
picture_as_pdfHealthHelp: Single Sign-On Capabilities
picture_as_pdfMember Outreach Form
picture_as_pdfNaviNet and Provider Portal Training Guide
picture_as_pdfNotice of Practice/Practitioner Changes Form
picture_as_pdfObstetrical Needs Assessment Form (ONAF)
picture_as_pdfOutpatient Behavioral Health Prior Authorization Request Form
picture_as_pdfOutpatient Therapy Services Prior Authorization Request Form
picture_as_pdfPCP Transfer Form
picture_as_pdfPNC Echo UI Users Guide
picture_as_pdfPrivate Duty Nursing (PDN) Prior Authorization Request Form
picture_as_pdfProvider Appeals Submission Form
picture_as_pdfProvider Complaint Forms
Provider Roster Worksheet (xlsx)
picture_as_pdfProvider Self-Audit Information
picture_as_pdfProvider Self-Audits Overpayments Form
picture_as_pdfQuality of Care/Quality of Service Concern External Reporting Form
picture_as_pdfReferral Request for Maternal Opioid Use Disorder (MOUD) Treatment
picture_as_pdfRequest for Medicaid Drug Exception Form
picture_as_pdfSSBCI Attestation Form
picture_as_pdfSterilization Consent Form
picture_as_pdfSubstance Abuse Prior Authorization Request Form
picture_as_pdfSUD 48-Hour Notification of Admission (ASAM) Form