Prior Authorization Resources
- Prior Authorization Code Check
- Certification of Need
- Empower Prior Authorization Form for Behavioral Health or Developmental Disability Providers
- Empower Prior Authorization Form for Medical Services
- Pharmacy PA form
- Quick Reference Guide for Key Contact Information and Prior Authorization
- Outpatient Behavioral Health Benefit Limits
- Outpatient ADDT Benefit Limits
- Outpatient Medical Benefit Limits
- Empower DME Specific Benefit Limits
- Pharmacy PA form
- UM Authorization Training
Provider Network Forms
- Provider Roster Form
- Out of Network Provider Portal Access Request
- 2020 Empower PCP PIP Attestation
- 2020 Empower QIP Attestation
- Access Site Visit Tool
- Network Application
Claims Forms
Incident Reporting Forms
Care Coordination Resources
- Email [email protected]
Claims Resources
- Empower ADDT Medicare Bypass Codes
- Empower EIDT Medicare Bypass Codes
- Empower Medicare Bypass Codes
- Empower Third Party Liability Bypass Codes
- Job Aid – Modifying a Claim submitted on the Empower Portal
- Job Aid – Provider Validation Requirements CMS 1500 Electronic CHC Connect Taxonomy
- Job Aid – Provider Validation Requirements for CMS 1500 via EDI
- Job Aid – Provider Validation Requirements for CMS 1500 via Provider Portal
- Job Aid – Provider Validation Requirements for UB04 via EDI
- Job Aid – Provider Validation Requirements for CMS 1500 Paper
- Job Aid – Provider Validation Requirements for UB04 Paper
- Provider Portal User Guide
- Tips for Completing the UB04 (CMS-1450) claim form
- Tips for Completing the CMS-1500 claim form
- Instamed ERA/EFT FAQ
Quality Improvement Resources
- Medical Record Documentation Review – Behavioral Health Physicians Checklist
- Medical Record Documentation Review – Primary Care Physicians Checklist