Forms
Member Grievance and Appeals Request Form (English | Spanish)
Medical Release Form (English | Spanish)
Authorization for the Use and Disclosure of PHI (English | Spanish)
Member access to PHI (English | Spanish)
Freedom of Choice (English |
Spanish | French Creole)
Direct Member Reimbursement (DMR) (English | Spanish)
CMS-0057 Prior Authorization Annual Report
This information tells you which services need approval before you get care and shows how many requests are approved, denied, or approved after an appeal. It also shows how fast decisions are made for regular and urgent requests, even when more time is needed to review them.