Provider Forms and Documents

Clover Information

• Clover Phone and Fax Numbers
• Clover Provider Manual
• Provider Newsletter

Waiver of Liability

• Waiver of Liability

Pre-authorization

• Medicare Part B and C Pre-authorization Request Form
• Participating Provider Pre-authorization List (Effective as of 3/15/2019)
• NaviNet: Member Eligibility and Benefit Verification

Plan Benefit Information

• 2019 Clover Medical Benefits 
  • Arizona
  • Georgia
  • New Jersey 
    • PPO Plans 001, 004 and 007 
    • PPO Plans 032, 041 and 042
    • HMO Plans 002 and 003
  • Pennsylvania
  • South Carolina
  • Tennessee
  • Texas 
    • Bexar County
    • El Paso County

Reference

• Provider Update Request Form
• Provider Tax ID Update Form
• Condition Management Guidelines
• Provider HMO Joinder
• Provider HMO Welcome Letter
• Prescription Drug Transition Policy
• Payment Disputes
• Readmissions Review Program

Part B Drug Treatment Policies 

• Fulphila
• Granix
• Hyaluronic Acid Derivatives
• Leukine
• Neulasta
• Neupogen
• Nivestym
• Remicade
• Simponi
• Udenyca
• Zarxio