Provider materials and forms

• Provider manual (PDF)
• Network Relations contact list (PDF)
  

FAQ for alcohol and substance use Screening, Brief Intervention, Referral to Treatment (SBIRT) (PDF)

Shared decision-making aids are communication tools used as a way for providers and patients to make informed health care decisions based on what is important to the patient.   They do not replace physician guidance but are intended to help complement the discussions between patients and physicians on treatment decisions.   

Below are evidence-based aids that provide information about treatment options, lifestyle changes, and outcomes.
 

• American Heart Association | Health Topics
• Diabetes | American Heart Association
• Flu Prevention | American Heart Association
• Heart Facts | American Heart Association
• Mayo Clinic | Care that fits
• Statin Choice | Mayo Clinic
• Depression Medication Choice | Mayo Clinic
• Cardiovascular Primary Prevention Choice | Mayo Clinic

• Kentucky Medicaid MCO Universal Prior Authorization form (PDF)
• Aetna physical health (PH) prior authorization request (PDF)
• Aetna behavioral health (BH) prior authorization (PDF)
• Aetna multisystemic therapy (MST) prior authorization (PDF)
• Aetna electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) request form (PDF)
• Aetna psychological and neuropsychological test request form (PDF)
• Aetna outpatient treatment request (OTR) form (PDF)
• Aetna applied behavioral analysis (ABA) OTR form (PDF)

• Case management referral form (PDF)
• Member authorization release for standard appeal (PDF)
• Primary care physician (PCP) change form (PDF)
• Prenatal notification form (PDF)
• Sterilization consent form (PDF)
• Provider grievance form (PDF)
• Provider appeal form (PDF)

• Portable Cribs Program Form (PDF)
• Promise Rewards Program Form (PDF)