ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Benefit/Service Types and Additional Benefit Notes (PDF)
လံာ်တီလံာ်မီတဖၣ်ဒီး လံာ်ကွီၣ်ဒိတဖၣ်အစၢတဖၣ်
တၢ်ပာ်ဖျါ 1521 - 1530 လၢ 3470 အစၢတဖၣ်အကျါ
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Availity Essentials Claim Submission (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Availity Essentials Appeal Submission FAQ (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Managed Care Referrals Submission (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Managed Care Referrals Inquiry and Update (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Psychological and Neuropsychological Testing Pre-Authorization Request Form (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Transplant Pre-Authorization/Prior Approval Request Form (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Medical Policy Coverage Exception form
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Formulary Exception and Tier Authorization - Only SecureBlue (HMO) (PDF)
ကသံၣ်ကသီပှၤဟ့ၣ်မၤစၢၤတၢ်
Step Therapy Authorization - Only for SecureBlue (HMO) (PDF)