Forms & publications

Notice: If you are looking for Apple Health (Medicaid) client forms and publications, please visit our Free or low-cost forms library.

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

Agreement to pay for healthcare services

13-879

This is an agreement between a “client” and a “provider” for healthcare service(s) that the Health Care Authority (HCA) will not pay.

Form

AH integrated foster care contract

Contract

AH integrated foster care wrap around

Contract

AH integrated managed care contract

Contract

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