Providers
Providers Forms
2010 PFFS Providers Terms & Conditions
2009 PFFS Provider Leaflet
2010 PFFS Provider Leaflet
Payment Dispute Decision Request Form
EDI Payer Number 50528
Medicare Masterpiece Authorization Request Form
U-First Authorization Request Form
2009 Quick Reference Guide
2009 Ophthalmology Guidelines
2010 Texas Quick Reference Guide
PFFS Claims (only) Provider Reconsideration Form
Provider Waiver Form
Wheelchair Medical Necessity Form
Medicare Risk Adjustment Model
1.
CMS-HCC Medicare Risk Adjustment Model Explanation
2.
ICD-9 Coding Tool 2010 Booklet
3.
MRA Encounter Form
a.
Single page Encounter Form 2010
b.
Two sided Encounter Form 2010
4.
Crosswalk between ICD9 to HCC 2010
5.
Provider Progress Note Documentation Memo
6.
Provider Signature and Abbreviations Log 2010
U.S. Preventive Services Task - “Guide to Clinical and Preventive Services”
Please use this form to contact us if you are interested in learning more about our products and services.
Name
Email Address
Phone Number
Questions / Comments
