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Forms

A library of the forms most frequently used by health care professionals. Please contact your provider representative for assistance.

  • Behavioral Health Concurrent Review Form
  • Behavioral Health Discharge Note
  • Behavioral Health Initial Review Form for Inpatient and Partial Hospital Programs
  • Blue Medicare Advantage General Precertification Request
  • Blue Medicare Advantage Fax Cover Sheet
  • Mental Health Outpatient Treatment Report Form
  • Request for Authorization: Neuropsychological Testing
  • Request for Authorization: Psychological Testing
  • Electroconvulsive Therapy Prior Authorization Request
  • Behavioral TMS Form
 
 

Provider tools & resources

  • Log in to Availity
  • Benefits and Pharmacy
  • Prior authorizations
  • Policies, manuals & guides
  • Referrals
  • Forms
  • Training Academy

Interested in becoming a provider in the network?

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Contact Us at Provider Services: 844-451-2057

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© 2021 Blue Medicare Advantage
Availity, LLC is an independent company providing administrative support services on our behalf.

Blue Medicare Advantage is the trade name of Group Retiree Health Solutions, Inc. an independent licensee of the Blue Cross and Blue Shield Association.

 

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