Provider Forms

 Client Registration

• Client Registration Form – Updated September 2017 (Word)
• Client Registration Desk Reference – Updated September 2017 (PDF)
• Client Registration Toolkit  Updated September 2017 (PDF)

Clinical Forms

• Covered Services Authorization Required (PDF)
• Authorization Reference Guide (PDF)
• Adverse Incident Report Form (PDF)
• Crisis Alert (PDF)

Handbook – WA Supplement

• Washington State ASO Provider Handbook: Supplemental Appendix (PDF)
• Washington State Medical Necessary Criteria – Updated 2017 (PDF)

ProviderConnect

• ProviderConnect Forms
• Login or register with ProviderConnect, an online tool that allows you to submit and check claims status, check member eligibility, update your provider profile, request inpatient and outpatient authorizations, and more. ProviderConnect is easy to use, secure and available 24/7.
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