Provider Manuals and Forms
Medicaid Manuals, Forms and Resources
- Medicaid Provider Manual
- Practice Guidelines
- Payment Policy Manual Note: This opens in a new window. To view a document, please click on the link icon next to its name.
The online Provider Manual represents the most up-to-date information on Absolute Total Care’s Medicaid Plan, programs, policies, and procedures. This manual sets forth the policies and procedures that providers participating in the Absolute Total Care network are required to follow. Contact Absolute Total Care Provider Service at 1-866-433-6041 if you have questions.
Forms
- Appointment of Authorized Representative Form (Member Consent Form)
- Makena/17P Prior Authorization Form
- MemberConnections Referral Form
- Claim Adjustment Form
- OB Provider Pregnancy Incentive Form
- Notification of Pregnancy Provider Form
- Abortion Statement
- Consent for Sterilization
- Universal Retail Medication Prior Authorization Form
- BabyNet Prior Authorization Form
- Inpatient Prior Authorization Fax Form
- Outpatient Prior Authorization Fax Form
- Provider Dispute Form
- Contract Initiation Application
- Provider Data Form (Add)
- Provider Data Form (Update)
Resources
Medicare-Medicaid (MMP) Manuals, Forms, and Resources
Manuals and Guides
The online Provider Manual represents the most up-to-date information on Absolute Total Care’s Medicare-Medicaid Plan (MMP), programs, policies, and procedures. This manual sets forth the policies and procedures that providers participating in the Absolute Total Care network are required to follow. Contact Absolute Total Care Provider Service at 1-855-735-4398 if you have questions.
Forms
- Outpatient Prior Authorization Form
- Inpatient Prior Authorization Form
- Medicare Prescription Drug Coverage Determination Form
- Provider Dispute Form
- Provider Survey Form
- Contract Initiation Application
- Provider Data Form (Add)
- Provider Data Form (Update)
Resources