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Downloading important patient forms here.

Please note: Prior authorization requirements vary by plan. Please contact HPI Provider Services or visit Access Patient Benefits to review your patient's plan description for a full list of services requiring prior authorization. Prior authorization forms below are only for plans using AchieveHealth™ CMS. Please verify the correct prior authorization vendor prior to submitting forms; unverified prior authorizations will be returned.

Standard Prior Authorization Request

 

If your patient's plan requires Prior Authorization for a service or procedure listed below, please complete the Standard Prior Authorization Request form in addition to the applicable form below.

 

Chemotherapy/Cancer Treatment Medication 

Pediatric/Adult Formula

Infertility Services

*Claim and reimbursement forms may not be applicable to all plans. Be sure to check your benefit details in your summary plan description prior to submitting a claim or reimbursement form.

Some forms on this page are in PDF format and require Adobe Reader to open.

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