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
ePayment Information
Digital Tools and Guides
- Altruista-Guiding Care Prior Authorization Education Guide
- New Provider Orientation Guide
- Provider Portal Overview Guide
- Medicare Advantage Overview Guide
- eviCore Resources
- Pharmacy Prior Authorization Provider Portal 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
Medicare Information
Star Ratings Fliers
- 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