Health Management Provider Resources
Visit the Provider Portal to view the prior authorization requirements, and to submit the Medical Necessity Determination form electronically.
If you have not yet registered for the Provider Portal, please download the flyer below for steps on setting up your multi-factor authentication (MFA).
Medical Helpline Maternity Helpline Form
Help us better support your patients by providing key details about their maternity care needs. Download and complete the Maternity Helpline form below.
Medical Helpline Transition of Care Form
Ensure a seamless care experience for your patients by sharing information about their transition of care needs. Download and complete the Transition of Care form below.
Prior Authorization Requests
For prior authorization, please complete the Request For Medical Necessity Determination form. You must verify benefits and eligibility prior to submission. Incomplete forms cannot be processed.
After completing form, fax request and clinical documentation to this secure fax at 714-809-6760.