Documents and Forms

DOCUMENTS AND FORMS

DOCUMENTS AND FORMS


 

Medical Referrals & Authorizations

Pharmacy

Billing

Mandatory Training Attestation

Provider Medical Assistance Program Enrollment Forms

Mental Health Professionals Medical Assistance Program Enrollment Forms (LCPC, LMFT, MSW, etc.)

Preventive Care (HEDIS®)

Vision Benefits

MeridianHealth offers vision benefits to members enrolled in specific health plans.

Click here to view a chart summarizing the vision benefits available to members in each of our Illinois health plans.

 

Instructions – Ordering Vision Hardware from Classic Optical Laboratories (for Medicaid and Medicare-Medicaid Alignment Initiative (MMAI) members)

  • NOTE: Please DO NOT contact Classic Optical about any prior authorizations

Order Form – Classic Optical Laboratories

Instructions – Ordering Vision Hardware from JAK Optical Laboratories (for Medicaid and Medicare-Medicaid Alignment Initiative (MMAI) members)

  • NOTE: Please DO NOT contact JAK about any prior authorizations

Order Form – JAK Optical Laboratories

Credentialing and Roster Update

EPSDT Forms

Regulatory Requirements Manual

Subcontractor Regulatory Requirements Manual

Advance Directives

State of Illinois Resources

Critical Incidents

Page Last Modified: 4/5/2022 2:50:09 PM