Provider Forms and Documents

Clover Information

• Clover updated PO Boxes
• Clover Phone and Fax Numbers

Provider Newsletter

• 2020 Q4 Provider Newsletter
• 2020 Q3 Provider Newsletter
• 2020 Q2 Provider Newsletter
• 2020 Q1 Provider Newsletter

Waiver of Liability

• Waiver of Liability

Pre-authorization

• Medicare Part B and C Pre-authorization Request Form
• Participating Provider Pre-authorization List
• Part B Drug Treatment Policies

Plan Benefit Information

• NaviNet: Member Eligibility and Benefit Verification

Reference

• Provider Update Request Form
• Provider Tax ID Update Form
• Condition Management Guidelines
• Provider HMO Joinder
• Provider HMO Welcome Letter
• Prescription Drug Transition Policy
• Claims Dispute & Appeal Form