Provider Forms and References
Reference Guides
- Doula: Submitting claims and member eligibility
- Family Guide to Autism Services - Chinese
- Family Guide to Autism Services - English
- Family Guide to Autism Services - Hindu
- Family Guide to Autism Services - Portuguese
- Family Guide to Autism Services - Spanish
- Family Guide to Autism Services - Tadjik
- Lead Screening Quick Reference Guide
- Leading the Way on Lead
- National Drug Codes Requirement for Claims Submission
- UnitedHealthcare Community Plan of New Jersey Appointment Availability and After-hours Standards
- Verifying Benefits and Billing Guidelines for New Jersey Network Health Care Providers
Provider Forms
- Critical Incident Reporting Form
- DOBI Claims Appeal Form
- Entity Disclosure of Ownership and Control Interest Form - Online Version
- Health Care Professional — Special Needs Survey Form
- Hysterectomy and Sterilization Procedures and Consent Forms
- Individual Disclosure of Ownership and Control Interest Form - Online Version
- Long-term Care Prior Authorization Fax Request Form
- Medication-assisted treatment and office-based addictions treatment questionnaire and attestation form
- Prior Authorization Forms
- Provider Disclosure of Ownership and Control Interest Statement form FAQ
- Synagis® Respiratory Syncytial Virus RSV Enrollment Form
- Specialist Referral Form
- Verbal risk assessment for lead toxicity
Submit a Pre-Service Appeal and or Grievance for a Medicaid Member