Provider Resources

Provider Materials

Manuals and Forms

• Provider Manual
• Medicare Provider Manual
• Provider Information Change Form
• Provider Information Addition Form
• Prospective Provider Form
• Preauthorization Request Form
• MHS Chiropractor Referral Form (for Memorial Health System Employees and Dependents only)
• Compliance Attestation Form

FAQs and Resources

Wellness Guides

• Be Healthy Wellness Guide
• Medicare Be Healthy Wellness Guide
• WA Individual Be Healthy Wellness Guide

Digital Tools and Guides

• eviCore March 2017 Preauthorization Presentation
• eviCore Resources
• Preauthorization Overview for Providers and Office Personnel
• YourHealthAlliance.org Overview for Providers and Office Personnel
• Clear Coverage Tutorial
• Compliance Training Presentation

And check out Coding Counts for regular updates on Risk Adjustment coding and ICD-10 updates.

Medicare

• 2019 Health Alliance Medicare Provider Education
• 2019 Health Alliance Northwest Medicare Provider Education
• 2019 Reid Health Alliance Medicare Provider Education
• 2018 IL Medicare Star Ratings Flier
• 2018 IL Medicare Star Ratings Flier – Spanish
• 2018 IA Medicare Star Ratings Flier
• 2018 IA Medicare Star Ratings Flier – Spanish
• 2018 WA Confluence Medicare Star Ratings Flier
• 2018 WA Confluence Medicare Star Ratings Flier – Spanish
• 2018 WA Pioneer Medicare Star Ratings Flier
• 2018 WA Pioneer Medicare Star Ratings Flier – Spanish
• 2018 WA SignalAdvantage Medicare Star Ratings Flier
• 2018 WA SignalAdvantage Medicare Star Ratings Flier – Spanish
• 2018 Reid Medicare Star Ratings Flier
• 2018 Reid Medicare Star Ratings Flier – Spanish

Pharmacy

Forms

• CVS Caremark Specialty Pharmacy Services Enrollment Form
• Morphine Equivalent Dose (MED)/Opioid Medication Supplemental Information Form
• Pharmacy Preauthorization Request Form

Drug Lists

• 2018 Individual and Employer Group Formulary – Public (QHP) Plans
• 2018 Individual and Employer Group Formulary – Direct Plans
• 2019 Health Alliance Individual and Small Group Formulary
• 2019 Health Alliance Northwest Individual and Small Group Formulary
• Health Alliance Northwest Emergency Fill List – Included Drugs
• Health Alliance Northwest Emergency Fill List – Excluded Drugs
• Specialty Drug List
• eviCore Medical Oncology Drug List

Medicare

• Medicare Illinois Pharmacy Directory
• Medicare Midwest Formulary
• Medicare Northwest Formulary
• High-Risk Medication Chart

Generics

• Help Patients Save on Meds Flier
• Antidepressants Comparison Guide
• ARB Antihypertension Comparison Guide
• Atypical Antipsychotics Comparison Guide
• Statin Comparison Guide

Credentialing and ePayment Forms

Credentialing Forms

• Provider Attestation Form

For any MDs, DOs, or DCs with their primary address in Illinois:

• IL Credentialing Form

For any provider with their primary address in Iowa:

• IA Credentialing Form

For any provider except Illinois MDs, DOs, DCs, and providers in Indiana:

• Health Alliance Provider Application

Under Indiana law, Indiana providers must use the CAQH form for credentialing:

• CAQH Form

ePayment Forms & Fliers

• ePayment Enrollment and Authorization Form
• Change Healthcare ePayment Flier