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Documents and Forms
Documents
AIM Portal Genetic Testing User Guide
AIM Portal Radiology and Cardiology Guide
Behavioral Health Panel Toolkit
CAHPS Reference Guide
Concurrent Use of Opioids and Benzodiazepines (COB)
COVID-19 Benefit and Reimbursement Policy FAQ
COVID-19 Diagnostic (Viral) Testing and Antibody (Serology) Testing Policy
COVID-19 Provider Relief FAQ
Dual Care (D-SNP) Quality Measures
InTouch for Providers Resource Guide
Medicare AWV Telehealth Component Guide
Medicare Stars Measurement Year (MY) 2024 Guidance for Providers
Minimizing Polypharmacy In Older Adults
Naloxone For Opioid Safety
Opioid Medication Coverage FAQ for Medicare Providers
PacificSource Provider Manual
Peer-to-Peer FAQ
Polypharmacy - Use of Multiple Anticholinergic Medications in Older Adults (POLY-ACH)
Provider Access Standards
Safety and Monitoring Program FAQ for High Risk Medications
Telemedicine and Telehealth FAQ
Tips for the Medicare Health Outcomes Survey Measures
TransactRx
Transitions of Care Metric Description and Workflow
Forms
Auto-Recoupment Enrollment Form
Care Coordination and Case Management Referral Form
Contested Refund Form
Corrected Claim Form
CVS Caremark Mail Order Prescription Fax Form for Prescribers
Dental Provider Contracting Interest Form
EFT/ERA Election Form
Health Services Prior Authorization Request Form
Hospice Pharmacy Prior Authorization Verification Form
Inpatient Utilization Review Form
Medicare Non-Coverage for Home Health
Medicare Non-Coverage for Skilled Nursing Facilities
Medicare Non-Coverage Instructions
Pharmacy Prior Authorization Form
Provider Appeal Form
Provider Contracting Interest Form - OR and WA
Provider Information Request - ID and MT
Provider Information Request - OR and WA
Provider OffShore Operations Attestation
Provider Ownership and Acquisition Change Request Form
Waiver of Liability for Non-Contracted Provider Claim Appeals