Physicians Health Plan has all of our commercial provider forms easily accessible at a click of a button. Please choose the form from the list below that best fits your needs.
The forms on this page are for commercial use only. Please review the instructions to access Medicare Advantage forms.
Provider Appeal Form Authorized Appeal Representative NSA Open Negotiation Form
Case Management Referral Form
Claim Adjustment Request Form Medical Records Submission Form
HAAP Ancillary Provider Application Hospital Application New Provider Request Form - FillableNew Provider Request Form - Excel Spread Sheet Provider Information Update Form
To remain compliant with CMS, State, and Federal guidelines, we require prompt notification if a PHP practitioner is no longer accepting new patients. You are required to complete the Provider Information Update Form and return it to us in one of the following ways. Thank you for your adherence to this policy.
Out-of-Network Authorization Request Form
PHP Notification/Prior Approval Table ABA Therapy Request FormBariatric Surgery Request FormDME Authorization Request FormHome Health Care Request FormMedication Authorization Form Outpatient Rehab Therapy Request Form Prior Authorization Request Form for Services Transplant Prior Approval Form
Billing Company Information Questionnaire
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