Medicaid Forms and Reference Materials
Last Updated: Monday, December 22, 2025
Medicaid Provider Manual
Provider Manual
Provider Rebranding Reference Materials
Highmark Wholecare New Branding - YouTube Video
Highmark Wholecare Rebranding FAQs for Providers
HealthHelp Reference Material
HealthHelp Reference Material
PHARMACY FORMS
Drug Exception Form
Drug Specific Prior Authorization Forms - Submit e-PA Requests via CoverMyMeds
Home Infusion Drug Request Form
Oncology and Supportive Therapy Request Form Submit requests via Navinet.
GENERAL PROVIDER FORMS & REFERENCES
2026 Fraud, Prevention and Dectection Plan
After Hours Services
Audit Plan Supplemental Guide
BetterDoctor Provider FAQ
CARC and RARC Adjustment Code Crosswalk
Certification for Expedited Review Form
Clinical Services Referral Guide
CMS UB04 Form
CMS-1500 Form
Consent for Provider to File a Grievance for Member
Consent to Release Health Information to Coordinate Physical and Behavioral Health Care
Cultural Competency Data Form
Electronic Billing Companion Document
EPSDT Billing Document
Family Planning Fax Cover Sheet
Fraud Waste and Abuse
FQHC RHC Billing Guide
How to Use the Provider Portal Search Tool
Language Identification and Interpretation Request Flyer
Language Form
Laws and Regulations
Lead Screening Analysis Form
MA30 - Hysterectomy English
MA30 - Hysterectomy Spanish
MA31 - Sterilization Form - English
MA300X - Medical Assistance Provider Order Forms for Providers
Maternity Outcome Authorization Form
Member Benefit Packages / Co-Pay Matrix
Member Outreach Form
Obstetrical Billing Guide
OB Care Enhancements Provider Training
Obstetrical Needs Assessment Form (ONAF)
Optum OB User Guide
Opioid - CDC Guideline for Prescribing Opioids for Chronic Pain
Outpatient Program Exceptions Request – Please submit via Navinet.
Pediatric Telehealth Guide
PNC Echo UI Users Guide
Practice/Provider Change Request Form
Provider Self-Audit Overpayments Form
Refund Form
School Vaccination Requirements
Structured Screening for Developmental Delays and Autism Spectrum Disorders
