Provider Resources

 Client Registration

• Client Registration Form (PDF)
• Client Registration Process (PDF)

Clinical Forms

• Facility Participating Medicare Template (PDF)
• Covered Services Authorization Required (PDF)
• Authorization Reference Guide (PDF)
• Critical Incident Report form (PDF)
• Critical Incident Reporting Procedures (PDF)
• Crisis Alert (PDF)
• Provider Dispute Resolution Request Form (PDF)
• Provider Dispute Resolution FAQ (PDF)

Handbook – WA Supplement

• Washington State ASO Provider Handbook Addendum (PDF)
• Change Healthcare’s InterQual® Behavioral Health Medical Necessity Criteria 
• Monthly Exclusionary OIG/SAM Attestation (PDF/Fillable)

ProviderConnect

• ProviderConnect Guides and Tutorials
• 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.
   

  Login Register Demo