Provider Resources

Provider Materials

Manuals and Forms

• 2017 Provider Manual
• 2017 Medicare Provider Manual
• Provider Information Change Form
• Prospective Provider Form
• Preauthorization Request 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
• YourHealthAlliance.org Provider and Office Personnel Guide
• Clear Coverage Tutorial

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

Medicare

• 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

Drug Lists

• 2018 Individual and Employer Group Formulary – Public (QHP) Plans
• 2018 Individual and Employer Group Formulary – Direct Plans
• Specialty Drug List
• eviCore Medical Oncology Drug List

Medicare

• IL Medicare Pharmacy Directory
• IL Medicare HMO and PPO Formulary
• IA and NE Medicare HMO and PPO Formulary
• WA Medicare HMO 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