Providers

2020 Plan Year

2020 Prior Authorization Form

2020 Prior Authorization and Referrals List

2020 Part B Drug Authorization List

2020 Clinical Practice Guidelines

2018 and 2019 Plan Year

2019 Provider Manual

2019 Clinical Practice Guidelines

2018 Clinical Practice Guidelines

Authorizations by Service Level

Authorization Request Form

Provider MOC Training and Attestation

Quality Improvement Program

Last Updated: Feb 13, 2020 @ 1:46 pm