Frequently Used Forms

The following is a list of the most commonly used provider forms. 

Call Coverage Information Form
Claim Appeal Form
Clinical Staff Update Form 
Designated Client Representative Form
Service Authorization Form
Provider Logon ID Request Form

Some of the forms on this page can only be viewed using Adobe Acrobat® Reader®. If you don't have Adobe Acrobat® Reader®, you can download a free copy by clicking here.

Click here to go to the Access Behavioral Care provider page for forms specific to Access Behavioral Care members.

Click here to go to the State Managed Care Network provider Web site (chpplusproviders.com) for forms specific to the CHP+ State Managed Care Network.

Click here to go to the Pharmacy Services page for forms related to retail pharmacy.