Forms & publications

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IV Iron request form

Use this form to request prior authorization for prescribing IV Iron.
Alternate language versions:

Justification for miscellaneous enteral nutrition procedure code (B9998)

Fax this form with your manufacturer’s wholesale invoice and physician’s prescription to obtain authorization prior to submitting your claim. Attach a typed and completed General Authorization for Information form to your request.
Alternate language versions:

Medicaid Billing Workshop for Dental Providers

A complete overview of the use of the ProviderOne portal, including direct data entry of claims, authorizations, verifying client eligibility, spenddown, and billing a client.

Nucala request form

Use this form to request prior authorization for prescribing Nucala (mepolizumab SC injection).
Alternate language versions: