Provider Materials

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General Items

Indiana Provider Directory September 2006
CareSource Indiana Preferred Drug
HIPAA Notice of Privacy Practices

Forms

 Electronic Claims Registration Form

 HealthWatch Documentation Form
 Prenatal Risk Assessment Form
 Prior Authorization Request Form
 Prior Authorization Request Form Pharmacy (online)
 Provider Grievance Appeal Form
 Provider Information Update Form
 Receipt of Hysterectomy Information Form
 Request for Non-Formulary Drugs Form
 Sterilization Consent Form (State Form 46314) 
 Synagis Prior Authorization Request Form (paper form)

 W-9 Worksheet

Preventive/Practice Guidelines

 Preventive Guidelines Ages 0-65+

 Practice Guidelines for Asthma
 Practice Guidelines for Diabetes
 Practice Recommendations for Diabetes Mellitus
 Algorithm for Depression Treatment
 Algorithm for Depression Pharmocotherapy
 Algorithm for Suicidal Ideation Assessment 

Newsletters

 ProviderSource: Spring 2006

 ProviderSource: Winter 2005
 ProviderSource: Fall 2005
 ProviderSource: Spring 2005


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