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Administrative Forms and Notices

Appointment of Representative (Form CMS-1696)*

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Covered Services & Prior Authorization Requirements

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Coverage Requests and Determinations

Durable Medical Equipment (DME)

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EDI Transactions Questionnaire Form

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Notice of Privacy Practices

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Request for Claim Review Form

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Prior Authorization Forms

FAQs: Prior Authorization Requests

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Standardized Prior Authorization Request Form – Mass Collaborative

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PA Form – Massachusetts Medication Requests

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PA Form – Repetitive Transcranial Magnetic Stimulation Request

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PA Form – Psychological and Neuropsychological Assessment

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PA Form – Cardiac Imaging

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PA Form – CT/CTA/MRI

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PA Form – PET – PET CT

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Claims Requirements

Claims Requirements 1500 Professional Form

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Claims Requirements UB Institutional Form

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CMS Provider Directory Requirements

Guidance to Verify Adequate Networks & Current Provider Directories

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Provider Directory Requirements

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