Envolve Vision (Medicaid, Medicare, Commercial/Ambetter, Child Welfare Specialty Plan, Serious Mental Illness, Children's Medical Services Health Plan) Effective date: October 1, 2021 1-800-531-2818 Delegated function: Coverage of Services (Vision), Provider Services 3 0 obj 0000008263 00000 n ERS | Community First Health Plans - Commercial We provide health care payment solutions and payment automation services that improve administrative efficiency and enable payers and providers to manage new strategies. Providers Vision Dental Pharmacy or 800-460-8988 Pharmacy Prior Authorization Department: 866-399-0928 To partner with Envolve for health benefit solutions, direct your business inquiry to 1-844-234-0810 or fill out the form below requesting more information. Envolve to Sponsor Texas Association of Health Plans Annual Conference | Envolve Health, Envolve to Sponsor Governing Magazine's UM Accreditation | Envolve Health, Envolve Supports Community Health Care Association of New York State (CHCANYS) | Envolve Health, Envolve Sponsors and Exhibits at the National Association of Community Health Centers Community Health Institute & Expo | Envolve Health, Envolve to Sponsor and Exhibit at Medicaid Health Plans of America Conference | Envolve Health, Envolve to Support International Foundation of Employee Benefit Plans Conference | Envolve Health, Envolve to Support Health Enhancement Research Organization (HERO) Forum | Envolve Health, Envolve to Support California Association of Health Plan's Annual Conference | Envolve Health, Envolve to Support the Employer Healthcare and Benefits Congress Conference | Envolve Health, Envolve to Support Florida Association of Health Plans Annual Conference | Envolve Health, Envolve Supports 2016 Annual National Urban League Conference, Expo | Envolve Health, Envolve to Sponsor World Congress Government Health Care Congress | Envolve Health, Envolve to Sponsor World Congress National Well-Being Conference | Envolve Health, Envolve Honored as Gold Winner in the 8th Annual 2016 Golden Bridge Awards | Envolve Health, Five Tips for Contact Lenses Safety | Envolve Health, Five Tips to Help You Stay on Track with Your Medications | Envolve Health, Eating for Your Sight: Five Foods for Healthy Eyes | Envolve Health, Five Medication Safety Tips to Protect Yourself and Others | Envolve Health, Protect Your Kids Vision with Tips for Children's Eye Health and Safety | Envolve Health, Envolve Partners with Greater Portland Health to Bring Free Eye Care to Portland Community | Envolve Health, Tips to Safeguard Your Little Ones for National Baby Safety Month | Envolve Health, Envolve recognized at annual National Health Information Awards | Envolve Health, Envolve and SilverSummit Healthplan Bring Vision Van Event to Reno Community | Envolve Health, Envolve Sponsors Michigan Association of Health Plans (MAHP) Summer Conference | Envolve Health, Envolve Brings Vision and Dental Screenings to the National Council of La Raza Family Expo | Envolve Health, Envolve at 2017 National Urban League Conference | Envolve Health, Envolve to Participate at the 7th Annual RISE West Summit | Envolve Health, Envolve to Sponsor and Present at AHIPs National Conferences on Medicaid, Medicare and Duals | Envolve Health, Envolve-wide Hurricane Harvey Relief Effort | Envolve Health, Preparation is Key to Weathering Disasters | Envolve Health, Envolve Dental Earns Two URAC Accreditations | Envolve Health, Envolve Participates at the National Association of ACOs Fall Conference | Envolve Health, Envolve Sponsors California Association of Health Plans 32nd Annual Conference | Envolve Health, Envolve Participates at the 7th Annual HEDIS and Quality Improvement Summit | Envolve Health, Envolve Re-ups Sponsorship of Community Health Care Association of New York State (CHCANYS) Annual Conference | Envolve Health, Envolve Sponsors the TAHP Managed Care Conference and Trade Show | Envolve Health, Envolve to Present and Exhibit at Medicaid Health Plans of America Conference | Envolve Health, Envolve Partners with Florida Association of Health Plans for their 2017 Annual Conference | Envolve Health, Strong Youth Strong Communities California Youth Summits | Envolve Health, Envolve Sponsors New York Health Plan Association Annual Conference | Envolve Health, Envolve Announces First-Time Sponsorship of South Carolina Alliance of Health Plans Annual Health Care Conference | Envolve Health, Envolve Sponsors Welcome Dinner at Louisiana Association of Health Plans Annual Conference | Envolve Health, Final Strong Youth Strong Communities Youth Summit Taking Place in Columbia, South Carolina | Envolve Health, Envolve Sponsors 27th Annual Health Benefits Conference & Expo | Envolve Health, Envolve Announces First Time Sponsorship of Medicaid Innovations Forum | Envolve Health, Envolve & Carolina Complete Health Provide Free Vision Screenings across North Carolina | Envolve Health, Envolve at the National Association of ACOs Spring Conference | Envolve Health, Envolve to Present at GlobalSTL Health Innovation Summit | Envolve Health, BMC Public Health Publishes Envolve Center Research on Efforts to Boost Participation in a Family-Centered Pediatric Obesity Intervention Program, Envolve Earns NCQA UM Accreditation | Envolve Health, Envolve Center for Health Behavior Change Announcement | Envolve Health, Breaking Down Barriers to Better Health | Envolve Health, Envolve Center Tests New Approach to Childhood Obesity | Envolve Health, Envolve Center Brings Promising Behavior-Based Healthcare Interventions to Light at AHIP National Conferences, Envolve Center Joins Industry Leaders at Health Innovation Summit: Dan Cave to Deliver Keynote, Envolve Center Leads Collaborative Effort to Reduce Impact of Social Determinants on Health, Envolve Center Researcher Awarded Grant from Center for Diabetes Translational Research, Answers to Substance Abuse Disorders | Envolve Health, How to Better Communicate Health Risks and Improve Health Outcomes: Probabilities and Proportions, How to Better Communicate Health Risks and Improve Health Outcomes: Self-Affirmation and Feeling Good, How to Better Communicate Health Risks and Improve Health Outcomes: Story-telling for More Impact, Is it Time for A New Years Absolution? EPSDT (Early and Periodic Screening, Diagnostic and Treatment). 0000004690 00000 n For Member Services and assistance, please contact the telephone number on the back of your Member ID card. B0$$_=E!GU(?1X*BsB =F_=$A2BO'aj"yK)*SVcf2\ki=;KxYR$sA+:.&?(eeX;c:sB$0< TL"!2B@A-S.aHO=oktFr R~Zm M5=Cz',UvkD(v$8U"tHzs)3x3*=z|0So|LS=! Provider Services for Medicaid 844-464-5634 Members: call the number on the back of your ID card or go to the plan site. Envolve to Sponsor Texas Association of Health Plans Annual Conference | Envolve Health, Envolve to Sponsor Governing Magazine's UM Accreditation | Envolve Health, Envolve Supports Community Health Care Association of New York State (CHCANYS) | Envolve Health, Envolve Sponsors and Exhibits at the National Association of Community Health Centers Community Health Institute & Expo | Envolve Health, Envolve to Sponsor and Exhibit at Medicaid Health Plans of America Conference | Envolve Health, Envolve to Support International Foundation of Employee Benefit Plans Conference | Envolve Health, Envolve to Support Health Enhancement Research Organization (HERO) Forum | Envolve Health, Envolve to Support California Association of Health Plan's Annual Conference | Envolve Health, Envolve to Support the Employer Healthcare and Benefits Congress Conference | Envolve Health, Envolve to Support Florida Association of Health Plans Annual Conference | Envolve Health, Envolve Supports 2016 Annual National Urban League Conference, Expo | Envolve Health, Envolve to Sponsor World Congress Government Health Care Congress | Envolve Health, Envolve to Sponsor World Congress National Well-Being Conference | Envolve Health, Envolve Honored as Gold Winner in the 8th Annual 2016 Golden Bridge Awards | Envolve Health, Five Tips for Contact Lenses Safety | Envolve Health, Five Tips to Help You Stay on Track with Your Medications | Envolve Health, Eating for Your Sight: Five Foods for Healthy Eyes | Envolve Health, Five Medication Safety Tips to Protect Yourself and Others | Envolve Health, Protect Your Kids Vision with Tips for Children's Eye Health and Safety | Envolve Health, Envolve Partners with Greater Portland Health to Bring Free Eye Care to Portland Community | Envolve Health, Tips to Safeguard Your Little Ones for National Baby Safety Month | Envolve Health, Envolve recognized at annual National Health Information Awards | Envolve Health, Envolve and SilverSummit Healthplan Bring Vision Van Event to Reno Community | Envolve Health, Envolve Sponsors Michigan Association of Health Plans (MAHP) Summer Conference | Envolve Health, Envolve Brings Vision and Dental Screenings to the National Council of La Raza Family Expo | Envolve Health, Envolve at 2017 National Urban League Conference | Envolve Health, Envolve to Participate at the 7th Annual RISE West Summit | Envolve Health, Envolve to Sponsor and Present at AHIPs National Conferences on Medicaid, Medicare and Duals | Envolve Health, Envolve-wide Hurricane Harvey Relief Effort | Envolve Health, Preparation is Key to Weathering Disasters | Envolve Health, Envolve Dental Earns Two URAC Accreditations | Envolve Health, Envolve Participates at the National Association of ACOs Fall Conference | Envolve Health, Envolve Sponsors California Association of Health Plans 32nd Annual Conference | Envolve Health, Envolve Participates at the 7th Annual HEDIS and Quality Improvement Summit | Envolve Health, Envolve Re-ups Sponsorship of Community Health Care Association of New York State (CHCANYS) Annual Conference | Envolve Health, Envolve Sponsors the TAHP Managed Care Conference and Trade Show | Envolve Health, Envolve to Present and Exhibit at Medicaid Health Plans of America Conference | Envolve Health, Envolve Partners with Florida Association of Health Plans for their 2017 Annual Conference | Envolve Health, Strong Youth Strong Communities California Youth Summits | Envolve Health, Envolve Sponsors New York Health Plan Association Annual Conference | Envolve Health, Envolve Announces First-Time Sponsorship of South Carolina Alliance of Health Plans Annual Health Care Conference | Envolve Health, Envolve Sponsors Welcome Dinner at Louisiana Association of Health Plans Annual Conference | Envolve Health, Final Strong Youth Strong Communities Youth Summit Taking Place in Columbia, South Carolina | Envolve Health, Envolve Sponsors 27th Annual Health Benefits Conference & Expo | Envolve Health, Envolve Announces First Time Sponsorship of Medicaid Innovations Forum | Envolve Health, Envolve & Carolina Complete Health Provide Free Vision Screenings across North Carolina | Envolve Health, Envolve at the National Association of ACOs Spring Conference | Envolve Health, Envolve to Present at GlobalSTL Health Innovation Summit | Envolve Health, BMC Public Health Publishes Envolve Center Research on Efforts to Boost Participation in a Family-Centered Pediatric Obesity Intervention Program, Envolve Earns NCQA UM Accreditation | Envolve Health, Envolve Center for Health Behavior Change Announcement | Envolve Health, Breaking Down Barriers to Better Health | Envolve Health, Envolve Center Tests New Approach to Childhood Obesity | Envolve Health, Envolve Center Brings Promising Behavior-Based Healthcare Interventions to Light at AHIP National Conferences, Envolve Center Joins Industry Leaders at Health Innovation Summit: Dan Cave to Deliver Keynote, Envolve Center Leads Collaborative Effort to Reduce Impact of Social Determinants on Health, Envolve Center Researcher Awarded Grant from Center for Diabetes Translational Research, Answers to Substance Abuse Disorders | Envolve Health, How to Better Communicate Health Risks and Improve Health Outcomes: Probabilities and Proportions, How to Better Communicate Health Risks and Improve Health Outcomes: Self-Affirmation and Feeling Good, How to Better Communicate Health Risks and Improve Health Outcomes: Story-telling for More Impact, Is it Time for A New Years Absolution? Developed in partnership with state governments, managed care organizations, and health plans with a robust, nationwide provider network, Envolve administers fully customizable, cost-effective programs that enable individuals to maintain eye health through preventive and specialized eye care services. General or Routine Questions: Call Provider Services at 1-844-518-9505 ( TTY 1-844-546-9713) Complex Questions or Concerns: Please use this Contact Us Form. Ohio Medicaid and Health Plans For Providers | Buckeye Health Plan The provisions outlined in these Plan Speciics shall prevail over any provision in the Envolve Vision Provider Manual which may conlict or appear inconsistent with any provision contained in this document. Weekly . 0 . How Supplemental Health Benefits Improve Patient Outcomes, Increase Medicaid Patient Engagement With Three Simple Steps, Why Understanding Behavioral Science Is Important To Engaging Members, Population Health Analytics & Management | Envolve Health. MSiO}4i% ECHO trains primary care clinicians to provide specialty care services. 0000023568 00000 n 9 0 obj 837 EDI Companion Guide - Now included in the Provider Office Manual. stream PPO Medical, Dental, and Vision plans available as well as a generous PTO policy. stream Envolve Vision provides expert eye care benefit services for Medicaid, Medicare, and Health Insurance Marketplace member products with more than 30 years of experience operating as a full-service, eye care speciality Health Management Organization (HMO). endobj We share the provider's vision of focusing on the needs of our members and clients. Five Healthy Dessert Swaps to Enjoy During the Holiday Season! | Envolve Health, No Equipment Needed: At-Home Workout Using Only a Towel, Envolve CEO Drew Asher Joins PCMA Board of Directors, Five Ways to Get Something Positive Out of Dealing with Your Emotions, Avoid Mindless Eating with these Five Tips, At-Home Activities to Boost Your Heart Rate and Your Health, Five Ways to Make Your Meals Better For Your Health, Envolve Sharing New COVID-19 Support Program, Envolve Wins Gold 2020 Hermes Creative Award, Envolve Awarded Communicator Award of Distinction, Five Easy Ways to Establish Proper Handwashing Behaviors, Envolve Awarded Bronze Stevie Award in 2020 American Business Awards, Boost Your Brain and Maximize Your Memory with Five Easy Tips, Tips on How to Communicate with Children During COVID-19 Pandemic, Five Simple Stretching Exercises to Improve Total Body Flexibility, The Benefits of Helping Others: Improve Your Health Through Good Deeds, Boost Your Energy and Mood with These Five Healthy Foods, Five Ways to Ease Back to School Stress for Kids, Five Ways to Lower Your Risk of Developing Gestational Diabetes, Strategies for Improving Rural Access to Primary Care, Five Foods that Naturally Help Lower Your Cholesterol, Five Health Benefits of Smiling and Laughing, How to Get Five Important Nutrients You Need to Maintain Health, Five Tips for Healthy Ears and Protecting Your Hearing, Five Natural Ways to Improve Hair, Skin, and Nail Health, How Remote Health Solutions Supplement In-Person Care Between Visits, Five Ways to Keep Your Energy Levels Up Throughout the Day, How to Combat the Challenges Facing Rural Healthcare, Health Plans Can Improve Medication Adherence Among Seniors Through Health Literacy, How Health Plans Can Help Senior Members Manage Their Conditions from Home, How Rural Providers Contribute to Whole Health of Communities, The Value and Use of Diagnosis Codes in Dental Practice, How Health Plans Can Promote Long-Term Telehealth Use. endstream endobj 1654 0 obj <>stream 0000032711 00000 n Health Plan Information - Kansas 0000076382 00000 n Secure Provider Portal - Sunflower Health Plan Providers cannot request to alter or remove reviews. PDF Envolve Vision Benefits, Inc. Including All Associated Subsidiaries 0000033394 00000 n Please Note:This form will send your message to your Envolve service provider as an email. stream 0000014897 00000 n endobj You will need Adobe Reader to open PDFs on this site. Read more about the importance of perfecting population health for payers and providers. PDF Clinical Policy: Routine Eye Examination and Visual Aids for - WellCare a4(Q* [wlC?X!1/^L9 P:#u|x*0A#!" Payspan offers healthcare reimbursement and payment systems that are secure, efficient, cost-effective choices for providers and payers. If you'd prefer, please use the toll-free number for more information or assistance. %PDF-1.7 % Provider Contracting & Credentialing Forms have been moved to the Contracting & Credentialing Forms page. 9Lxx$ZiGZYI. Workout center available in the building! endstream endobj 1651 0 obj <>/Metadata 97 0 R/Pages 1648 0 R/StructTreeRoot 206 0 R/Type/Catalog>> endobj 1652 0 obj <>/MediaBox[0 0 612 792]/Parent 1648 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1653 0 obj <>stream This Envolve Dental provider manual supplies useful information about working with us. 0000014453 00000 n If you are a member of the media, please contact mediainquiries@envolvehealth.com. Please see the Ambetter from Sunflower Health Plan website. 0000032560 00000 n %PDF-1.5 % <<7410A90B714FE94587D1A7B635ACF1B4>]/Prev 235332/XRefStm 2326>> How to Use This Manual Envolve Vision is committed to working with our Provider community and Members to provide a high level of satisfaction in delivering quality healthcare benefits. <> startxref 8 0 obj endobj | Envolve Health, The Envolve Center for Health Behavior Change Barriers to Better Health Video Wins Award, The Wrong and Right Way to Brush Teeth Upgrade Your Routine | Envolve Health, How to Never Get Tired - Tips from People Who Don't | Envolve Health, Health Promotion Practice Publishes Envolve Center Research on Health Coaching-Related Terms and Associations, 5 Protein Rich Breakfast Foods to Fuel Your Body | Envolve Health, Knowledge Not Enough to Drive Behavior Change | Envolve Health, The psychology behind food indulgences: How we trick ourselves into thinking overeating is fine and that well bounce back quickly, Envolve Presents Diabetic Retinopathy Quality Initiatives at Texas Association of Health Plans Fall Directors Forum, Envolve Center Research to Be Presented at Americas Health Insurance Plans Medicare, Medicaid and Duals Conference, Social Norm Marketing Tactics for Health Communications | Envolve Health, Health Benefits of Tea - Infographic | Envolve Health, Envolve Provides Childrens Home Network with Oral Health Books in Honor of National Dental Hygiene Month, Make This Year Different: Behavioral Science Will Teach You How to Keep Your New Year's Resolution, Envolve Center/LA Healthcare Connections Diabetes Study | Envolve Health, The Future of Rx Benefits: Takeaways from Envolve at Medicaid Innovations Forum | Envolve Health, Dr. Jeremy Corbett Addresses Attendees at the Population Health Management Summit for Payers and Providers, Five Ways to Prevent Asthma Attacks in Children | Envolve Health, Five Quick Workout Tips for Busy Women | Envolve Health, Envolve Named 2019 Aster Winner | Envolve Health, Envolve Recognized as Bronze Stevie Award Winner in 2019 American Business Awards, Achieving Better Outcomes, Lower Cost with a Healthcare Benefits Management Partner, Five Ways to Avoid the Health Risks of Being Too Busy, How Vision and Dental Benefits Positively Impact Member Engagement and Health Outcomes, Envolve Panel Addresses How Unmet Basic Needs Impact Health Behaviors of Low-Income and Diabetic Populations, Five Tips to Keep Kids Safe During the Holidays, Human-Driven Technology Allows Fewer Clinicians to Care for More Patients, Five Ways to Workout When It's Cold Outside, Five Ways to Get Creative to Reduce Holiday Stress, Tapping Into Small Data for Bigger Results, How to Have a Successful First Doctor's Appointment with Baby, Five Tips for Protecting Your Eyes This Winter, Five Signs Your Child Has a Toothache - Even if They Can't Tell You it Hurts, Behavior Change Theorem: Using a Debt Model to Promote Whole Patient Health, Tech, Personalized Care, and Population Health Brighten the Future for Diabetes Patients | Envolve Health, Five Ways Relationships Are Good for Your Health, Five Tips to Help You Recover From a Heart Attack, Five Easy Ways to Lower Your Sodium Intake, Health Benefits of Spring Fruits & Veggies, Personalized Healthcare Is the Future, But We're Not There Yet | Envolve Health, Can Artificial Intelligence Humanize Patient Care? | Envolve Health, No Equipment Needed: At-Home Workout Using Only a Towel, Envolve CEO Drew Asher Joins PCMA Board of Directors, Five Ways to Get Something Positive Out of Dealing with Your Emotions, Avoid Mindless Eating with these Five Tips, At-Home Activities to Boost Your Heart Rate and Your Health, Five Ways to Make Your Meals Better For Your Health, Envolve Sharing New COVID-19 Support Program, Envolve Wins Gold 2020 Hermes Creative Award, Envolve Awarded Communicator Award of Distinction, Five Easy Ways to Establish Proper Handwashing Behaviors, Envolve Awarded Bronze Stevie Award in 2020 American Business Awards, Boost Your Brain and Maximize Your Memory with Five Easy Tips, Tips on How to Communicate with Children During COVID-19 Pandemic, Five Simple Stretching Exercises to Improve Total Body Flexibility, The Benefits of Helping Others: Improve Your Health Through Good Deeds, Boost Your Energy and Mood with These Five Healthy Foods, Five Ways to Ease Back to School Stress for Kids, Five Ways to Lower Your Risk of Developing Gestational Diabetes, Strategies for Improving Rural Access to Primary Care, Five Foods that Naturally Help Lower Your Cholesterol, Five Health Benefits of Smiling and Laughing, How to Get Five Important Nutrients You Need to Maintain Health, Five Tips for Healthy Ears and Protecting Your Hearing, Five Natural Ways to Improve Hair, Skin, and Nail Health, How Remote Health Solutions Supplement In-Person Care Between Visits, Five Ways to Keep Your Energy Levels Up Throughout the Day, How to Combat the Challenges Facing Rural Healthcare, Health Plans Can Improve Medication Adherence Among Seniors Through Health Literacy, How Health Plans Can Help Senior Members Manage Their Conditions from Home, How Rural Providers Contribute to Whole Health of Communities, The Value and Use of Diagnosis Codes in Dental Practice, How Health Plans Can Promote Long-Term Telehealth Use. %%EOF Out of date browser detected. July 1 - 7, 2021. endobj Learn More Contact Us Contact Us 0000013797 00000 n July 8, 2021. show Social Determinants of Health Insights submenu, show Population Health Analytics & Management | Envolve Health submenu, Member Services, Eligibility & Enrollment, Informatics, Data Aggregation & Analytics, Keeping Pace with Social Determinants of Health, Strategies for Payer-Provider Collaboration Around Social Determinants of Health, Choosing the Right Approach to Social Determinants of Health, Perfecting Population Health Survey Brief, Advice in Action: Trends and Best Practices in Influencing Patient Behavior, Hall of Fame Names Envolve and Centene as Official Youth Wellness Partner | Envolve Health, Washington DC Welcomes SeeMore the Envolve Vision Van | Envolve Health, Envolve Joins Marys Center for the Heroes to Care Health Fair on Veterans Day, Envolve Wins Gold Stevie Award | Envolve Health, Follow SeeMore, the Envolve Vision Van, on his Holiday Travels | Envolve Health, Eye Health Tips in Honor of Glaucoma Awareness Month | Envolve Health, Is it the Flu or a Cold? Envolve Vision Unsupported browser detected Contact Us Close Please note. <>/Metadata 1616 0 R/ViewerPreferences 1617 0 R>> A New Name for Superior's Pharmacy and Vision Providers This means more people can get the care they need. Envolve does not accept responsibility or liability for any loss or damage arising from the use of email. Wellcare (Medicare) New Provider Orientation, Wellcare By Allwell 2023 In-Network Provider Acknowledgment, Wellcare By Allwell 2024 In-Network Provider Acknowledgment, SSBCI Attestations for Chronically Ill Members, Member Day at the KCK Farmers Market at Catholic Charities | Sunflower Health Plan, Member Day at the KCK Community College Campus Farmers Market | Sunflower Health Plan, Ambetter from Sunflower Health Plan website, Provider resources, forms and manuals can be found here, Envolve Dental Kansas Plan Specifics (PDF), Envolve Pharmacy Solutions Provider Manual (PDF), Provider Quick Reference Guide (QRG) (PDF), Corrected Claims Quick Reference Guide (QRG), Sunflower Member ID Card Reference Sheet (PDF), Pregnancy Quick Reference Guide for Providers, KAN Be Healthy (KBH) and Early and Periodic Screening, Diagnostic, Treatment (EPSDT) Guide, Coordination of Benefits Entry Walk-Through Guide (PDF), PCSP and Completing the PCSP Signature Addendum (PDF), Quality Care Pointers for Providers (PDF), Preventive and Clinical Practice Guidelines, Consumer Access Guide to HCBS Services in Kansas, Unsolicited Overpayments, Refunds Worksheet (XLS), Outpatient Prior Authorization Form (PDF), Provider Reconsideration and Appeal Form (PDF), Provider Request for External Independent Third Party Review (EITPR) Form (PDF), Authorized Representative Designation Form (PDF), Discharge Consultation Documentation (PDF), Behavioral Health UM Inpatient Request (PDF), Electroconvulsive Therapy (ECT) Authorization Request Form (PDF), Inpatient Neuropsychological Testing Authorization Request Form (PDF), Outpatient Psychological Testing Authorization Request Form (PDF), Psychiatric Residential Treatment Facilities (PRTF) Prior Authorization Request (DOCX), Prior Authorization for Supported HousingOperation Community Integration (OCI) Program (PDF), Parent Management Training Oregon Request Form (PDF), Pharmacy Solutions MAC Pricing Inquiry Form, Sunflower KanCare Provider Directory (PDF).
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