Forms

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Contracting and Practice Changes

• Update Your Information – Please submit any changes for your practice using the HAP Provider Change Form.

Medical Prior Authorization

• Navigate Prior Authorization Request Form

Claims

• Navigate Member Claim Form
• Navigate Itemized Bill Cover Sheet

Grievances and Appeals

• Navigate Consent for Provider to file an Appeal Form

Fraud, Waste and Abuse

• Navigate Fraud Waste and Abuse Reporting Form