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2024 Marketplace Provider Manual
2023 Marketplace Provider Manual
Prior Authorization LookUp Tool
2024 Q1 Marketplace Prior Authorization Code Matrix
2024 Q2 Marketplace Prior Authorization Code Matrix
2024 Q1 UT Marketplace Prior Authorization Guide & Request Form
2024 Q2 UT Marketplace Prior Authorization Guide Request Form
Medical Benefit (HCPCS/J-Code) Drug Prior Authorization Request Form
Request Prior Authorization for Medication form (Marketplace)
Synagis Prior Authorization form 2023-2024
No Surprises Act - Independent Dispute Resolution Form (Non-Contracted Providers only)
Contract Request Form
Provider Information Change Form
In Office Lab Test List
Behavioral Health Higher Level of Care