Forms and referrals
We want to make it easy to work together so our members, and your patients, have the best experience possible. Here you can access important provider forms and learn how to refer a patient to CCA Health.
Jump to: Administrative Forms & Notices | Prescription Drugs Information | Provider and Network Information | Access to Care Standards Information | Claims, Billing, and Payment Information | Administrative Forms
Refer a Patient
Together we can create a better experience and better outcomes for your patients with complex needs.
Administrative Forms & Notices
Physician Peer-to-Peer Request Form
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Prescription Drugs Information
Provider & Pharmacy Directory
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Provider and Network Information
Choice and Plus Drug Formulary (2022)
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Medication Transition Process
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Drug Quality and Utilization Management
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CCA Medicare Excel 001 Drug Formulary (2023)
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Access to Care Standards Information
Access to Care Standards
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Primary Care Timely Access to Care Standards
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Claims, Billing, and Payment Information
Claim Submission Formats and Timeframes
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Claims Processing and Payment
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Member Balance Billing
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Provider Payment Dispute and Appeal Processes
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Drug Prior Authorization Request Form
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Administrative Forms
Provider Dispute Resolution Request Form
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Waiver of Liability Form
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