Find Your Plan
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A form to request reimbursement for out of pocket payment of prescription drugs
A list of Special Enrollment reasons and verification documents
A form to allow MHC to release information to someone else
A form to authorize monthly payments
A form to report changes to off exchange coverage
Information on your appeal rights.
Click to go to an online form to file an appeal.
All procedure codes requiring preauthorization
Medical Services Electronic Form
Behavioral Health/Substance Treatment
Skilled Nursing Facility & Acute Rehab
Home Health Care Services
Consent Allowing You to Appeal on Behalf of your Patient
Prior Authorization Request Form