Forms and Resources
Contracting
Non Participating Providers
Credentialing
- CAQH Brochure (PDF)
- Hospital Ancillary Clinic Credentialing Application (PDF)
- Magnolia Credentialing Application Packet (PDF)
- MID Form (PDF)
- Ownership and Controls Disclosure Form (PDF)
- Provider Data Form (PDF)
- Provider and Practitioner Credentialing Rights (PDF)
- Provider Update Form for Contracted Providers (PDF)
- W-9 Form (PDF)
- Prior Authorization List (PDF)
- Inpatient Prior Authorization Form (PDF)
- Outpatient Prior Authorization Form (PDF)
- Prior Authorization Tips - Urgent Requests
- Prior Authorization Tips - Timeliness of Prior Authorization Requests
- Prior Authorization Tips - Non-Participating Providers Documentation Requirements
- Prior Authorization Tips - Doctor's Orders
- Prior Authorization Tips - Do Not Use Copies of Old PA Forms
- Prior Authorization Tips - How to Fill Out the PA Form
- Prior Authorization Tips - Removal of PA for Observation, CPAP and BiPAP
For Ambetter information, please visit our Ambetter website.