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Provider materials and forms

Materials

Provider manual (PDF)

Log in to SKYGEN USA to access the dental manual.

Programs and resources quick reference guide (PDF)

Notice of change to complaints, grievances and appeals process (PDF)

Billings and claims quick reference guide (PDF)

Provider timely submission guide (PDF)

Submitting claims with Office Ally^TM (PDF)

Shared decision-making aids are communication tools used as a way for providers and patients to make informed health care decisions based on what is important to the patient. They do not replace physician guidance but are intended to help complement the discussions between patients and physicians on treatment decisions.

Below are evidence-based aids that provide information about treatment options, lifestyle changes, and outcomes.

American Heart Association | Health Topics

Flu Prevention | American Heart Association

Congenital Heart Defects | American Heart Association

Children and Arrhythmia | American Heart Association

Mayo Clinic | Care that fits

Depression Medication Choice | Mayo Clinic

Diabetes Medication Choice | Mayo Clinic

Forms

Obstetrical needs assessment form (PDF)

Environmental lead investigation request form (PDF)

Special needs case management referral form (PDF)

Sterilization consent form (PDF)

Out of network request to join form (PDF)

Provider appeal form (PDF)

Provider information change form

Web portal fax cover form (PDF)

Web portal registration form (PDF)

Prior authorization checklist (PDF)

Prior authorization request form (PDF)

Pharmacy prior authorization form (PDF)

Antidepressants (PDF)

Atypical antipsychotics long-acting injectables (PDF)

Atypical antipsychotics oral (PDF)

CNS Stimulants for ADD/ADHD (PDF)

Hepatitis C (PDF)

Monoamine depletors (PDF)

Opioids long- and short-acting (PDF)

Helpful links

Availity Provider Portal

Availity Provider Portal registration resources

Pennsylvania Children’s Health Insurance Program (CHIP)

Pennsylvania Department of Human Services

Member materials and forms

Find all the materials and forms a member might need — right in one place. 

Materials and forms