Provider Materials
Compliance Forms
Provider Addition and Change Forms
Credentialing Forms
Appeal Forms
Prior Authorization and Referral Forms
- Prior Authorization Request Form
- Prior Authorization & Clinical Review Criteria
- Illinois Uniform Electronic Prior Authorization
- Substitution Code Crosswalk Table
- Provider Reference Checklist – Acute Inpatient/Mental Health/Substance Abuse
- Provider Reference Checklist – EviCore
- Provider Reference Checklist – Outpatient
- Provider Reference Checklist – Post Acute
- Provider Reference Checklist – Transplant (Admissions)
- Provider Reference Checklist – Transplant Center
- SNF Clinical Checklist
- SNF Clinical Checklist FAQ
- Ancillary/Facility Credentialing Checklist
- Provider Credentialing Checklist
ePayment Information
Digital Tools and Guides
- New Provider Orientation Guide
- Medicare Advantage Overview Guide
- eviCore Resources
- Pharmacy Prior Authorization Provider Portal Guide
- Link to Health Alliance Provider Training Recording
- Health Alliance Tapestry Link User Guide
Provider Education Tools
Pharmacy
Forms
Health Alliance Northwest Emergency Fill List
High Risk Medications
Drug Lists
Generics
Formularies
Medicare
Individual and Small Group
Large Group
Tip Sheets
Quality Measure Tip Sheets
- Breast Cancer Screening
- Controlling Blood Pressure
- HbA1c Poor Control
- Colorectal Cancer Screening
- Diabetic Eye Exam
- Statin Therapy for Patients with Cardiovascular Disease
- Statin Use in Persons with Diabetes Tip Sheet
- Child and Adolescent Well-Care Visits
- Prenatal and Postpartum Care
- Exclusion Codes
- Depressive Disorder
- Diabetes Mellitus