Forms & publications

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Acute Physical Medicine and Rehabilitation Billing Guide (2020-10-01)

Provider billing guide

Add supporting documents to an existing authorization

A step-by-step guide for providers on adding additional supporting documents to a request in “pend” or “approve/hold” status.

Publication

Adding new users and assigning profiles

A resource for social service providers on adding new users to their domain and assigning profiles.

Publication

ADHD age and dose

Policy

ADHD therapy duplication

Policy

Adjust, void, and resubmit social service claims

Instructions for social service providers on how to adjust, void, or resubmit a social service claim through ProviderOne.

Publication

Adjust, void, and resubmit social service medical claims

A resource for social service medical providers on adjusting, voiding, or resubmitting a social service medical claim through ProviderOne.

Publication

Administrative services organization contract

Contract

Affidavit of Lost, Stolen, or Destroyed Warrant (09-014)

09-014

Providers: Submit this form to request a replacement warrant (i.e., check).

Form

Agreement of Acceptance (partial denture)

13-965

Complete this form when provisioning all partial dentures.

Form

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