Forms

Below is a list of some commonly used forms you may need as an AvMed care provider. The files are in Adobe's portable document format (PDF). To order a copy of a form you do not see listed below, call our Provider Service Center at (800) 452-8633, or send an e-mail to .

• Authorization Request Fax Form
• AvMed Health Plans Order Form
• AvMed Verification Form
• CareCore Authorization Request Form
• Care Management Referral Form
• Coordination of Benefits Claim Form
• CuraScript Referral Form
• Directory Information Change Form
• Home Health Care Agency Service Request Form
• Medication Exception Request Form
• NPI Provider Notification Form
• Physician Request for Home Health Care Services Form
• Provider Interest Form
• Provider Interest Form  (Hospital-Based and Ancillary Service Providers)
• Request for Claim Review / Appeal
• Request for Claim Status

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Last modified July 24, 2008