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The files below are in PDF format.
March 2023
February 2023
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December 2022
November 2022
October 2022
September 2022
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April 2022
March 2022
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January 2022
December 2021
November 2021
October 2021
September 2021
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July 2021
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April 2021
March 2021
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January 2021
Prior Authorizations Pre-Service Review Guide
Medical Prior Authorization Request Form
Pharmacy Prior Authorization Form
Behavior Health Prior Authorization Form
Prior Authorization Codification List - 2023 - Q1
Prior Authorization Codification List - 2022 - Q4
Prior Authorization Codification List - 2022 - Q3
Prior Authorization Codification List - 2022 - Q2
Prior Authorization Codification List - 2022 - Q1
Prior Authorization Codification List - 2021 - Q4
Prior Authorization Codification List - 2021 - Q3
Prior Authorization Codification List - 2021 - Q2
Prior Authorization Codification List - 2021 - Q1
Prior Authorization Codification List - 2020 - Q4
Prior Authorization Codification List - 2020 - Q3
Prior Authorization Codification List - 2020 - Q2
Prior Authorization Codification List - 2020 - Q1
Illinois Hospital Health Care System Service Area Map
Illinois Service Area - Ancillary
Illinois FQHCs, RHCs, and ERCs
Molina Authorized Representative Designation Form
Molina Claim-Issue Template (download)
CAQH Form
Claims Dispute Request Form
Health Delivery Organization (HDO) Form
Open Panel Form
Patient Change of Address Form
Pregnancy Notification Form
Provider Contract Request Form
Provider Information Update Form
Provider Memo: Improve Service and Increase Efficiency: Enroll in EFT/ERA
Provider Profile and EFT Registration Form
Request to Change PCP Form
Universal IAMHP Roster Template (download)
W-9 Form
2023 Medicaid Redetermination FAQ
Availity - How To Open a Support Ticket
Availity Appeal a Claim
Availity Atypical Provider Registration
Availity Checking Appeal Status
Availity Claim Status Tool Training
Availity Claims and Smart Claims
Availity Core Features
Availity Functionality Roadmap
Availity Multiple PA Requests
Availity Smart Claims Training
Availity Sunsetting Legacy Portal
Availity Sunsetting Legacy Portal Reminder
Critical Incident Reference Guide
FQHC Encounter Clinic Billing Quick Reference Guide
Guide to HFS MEDI Eligibility Search
Guide to Provider Changes
IDPH COVID-19 Paxlovid Checklist Tool for Prescribers
Marketplace Providers FAQ
Marketplace Providers Quick Reference Guide
New Century Health Data Sheet, Cardiology
New Century Health Data Sheet, Oncology
New Century Health FAQ Quick Reference Guide
Open Enrollment Guide
Patient Health Resources
Provider Roster Template Frequently Asked Questions
Quick Reference Contact Sheet
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