- Prior Authorization (UM) Form
- Care Management Referral Form
- Transportation Request Form
- Meal Service Authorization/Referral Form
- Coverage Determination Request Form
- Coverage Redetermination Request Form
- Request for a Reconsideration (Appeal) Form for Inpatient and/or Outpatient Services
- Grievance Intake Form
- Physician Certification Form for Ambulance Transport
- MedImpact Direct Mail Order Form
- OTC Mail Order Catalog – Medline*
Quick Reference Guides
Benefit Overview for Members
*Catalog does not apply to MoreCare Home (I-SNP) members.