Provider Forms - Form - 2025

Provider Attestation for OTC Plus Special Supplemental Benefits

Submit this form so your patient can use their OTC benefits for food and utilities.

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Provider Forms - Form - 2025

Podiatry and Peripheral Vascular Disease Prior Authorization Request

Use this form when requesting prior authorization of Podiatry and Peripheral Vascular Disease services for Healthfirst members

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Provider Forms - Form - 2025

Outpatient Physical Therapy, Occupational Therapy, and Speech Therapy Prior Authorization Request

Use this form when requesting prior authorization of physical, occupational, or speech therapy services for Healthfirst members.

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Provider Forms - Form - 2025

Children and Family Treatment Support Services (CFTSS) Continuing Authorization Request Form

Healthfirst is requesting concurrent review at the fourth visit for Community Psychiatric Supports & Treatment (CPST) and Psychosocial Rehabilitation (PSR). The CFTSS provider should complete this form when requesting continuation of services and submit the current CFTSS Treatment Plan, if available.

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Provider Forms - Form - 2025

Children's HCBS Authorization and Care Manager Notification Form

The Children’s Waiver HCBS Provider must complete this form for Children’s Waiver HCBS beyond the initial service period of 24 hours/96 units/60 days.

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Provider Attestation for OTC Plus Special Supplemental Benefits

Podiatry and Peripheral Vascular Disease Prior Authorization Request

Outpatient Physical Therapy, Occupational Therapy, and Speech Therapy Prior Authorization Request

Children and Family Treatment Support Services (CFTSS) Continuing Authorization Request Form

Children's HCBS Authorization and Care Manager Notification Form

Resource Type

Filter

Year

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Provider Attestation for OTC Plus Special Supplemental Benefits

Podiatry and Peripheral Vascular Disease Prior Authorization Request

Outpatient Physical Therapy, Occupational Therapy, and Speech Therapy Prior Authorization Request

Children and Family Treatment Support Services (CFTSS) Continuing Authorization Request Form

Children's HCBS Authorization and Care Manager Notification Form

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