ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Availity Essentials Claim Submission (PDF)
လံာ်တီလံာ်မီတဖၣ်ဒီး လံာ်ကွီၣ်ဒိတဖၣ်အစၢတဖၣ်
တၢ်ပာ်ဖျါ 1121 - 1130 လၢ 3159 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Availity Essentials Appeal Submission FAQ (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Benefit/Service Types and Additional Benefit Notes (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Substance Use Disorder Concurrent Request Form (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Formulary Exception and Tier Authorization - Only SecureBlue (HMO) (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Step Therapy Authorization - Only for SecureBlue (HMO) (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Inpatient Admission Notification and Prior Authorization Request Form (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Inpatient Rehabilitation & Skilled Nursing Facility Admissions Prior Authorization Request Form
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Long Term Acute Care (LTAC) Facility Admissions Prior Authorization Request Form
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Early Intensive Behavioral Intervention (EIBI) Services Pre-Authorization Request Form (PDF)