{"id":2072,"date":"2023-11-16T18:18:17","date_gmt":"2023-11-16T18:18:17","guid":{"rendered":"https:\/\/alliantplans.com\/?page_id=2072"},"modified":"2026-04-15T13:01:58","modified_gmt":"2026-04-15T17:01:58","slug":"provider-forms-and-documents","status":"publish","type":"page","link":"https:\/\/alliantplans.com\/providers\/provider-forms-and-documents\/","title":{"rendered":"Provider Forms and Documents"},"content":{"rendered":"<style>.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1440px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var(--global-kb-spacing-xxl, 5rem);padding-bottom:var(--global-kb-spacing-xxl, 5rem);grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2072_a24b52-b6 > .kt-row-layout-overlay{opacity:0.10;}@media all and (max-width: 1024px){.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2072_a24b52-b6 alignfull has-theme-palette1-background-color kt-row-has-bg wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column2072_f5db25-f7 > .kt-inside-inner-col,.kadence-column2072_f5db25-f7 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_f5db25-f7 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_f5db25-f7 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_f5db25-f7 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_f5db25-f7 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_f5db25-f7{text-align:left;}.kadence-column2072_f5db25-f7{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_f5db25-f7 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_f5db25-f7 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_f5db25-f7 kb-section-dir-vertical inner-column-1\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b, .wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b[data-kb-block=\"kb-adv-heading2072_9fd77b-6b\"]{margin-top:0px;text-align:center;line-height:1.2em;font-style:normal;text-transform:uppercase;}.wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b[data-kb-block=\"kb-adv-heading2072_9fd77b-6b\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b[data-kb-block=\"kb-adv-heading2072_9fd77b-6b\"] img.kb-inline-image{width:150px;vertical-align:baseline;}<\/style>\n<h1 class=\"kt-adv-heading2072_9fd77b-6b wp-block-kadence-advancedheading has-theme-palette-9-color has-text-color\" data-kb-block=\"kb-adv-heading2072_9fd77b-6b\">Provider Forms and Documents<\/h1>\n<\/div><\/div>\n\n<\/div><\/div>\n\n<style>.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1440px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var(--global-kb-spacing-md, 2rem);padding-right:var(--global-kb-spacing-xxs, 0.5rem);padding-bottom:var(--global-kb-spacing-xl, 4rem);grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2072_3fa05d-30 > .kt-row-layout-overlay{opacity:0.30;}.kb-row-layout-id2072_3fa05d-30 ,.kb-row-layout-id2072_3fa05d-30 h1,.kb-row-layout-id2072_3fa05d-30 h2,.kb-row-layout-id2072_3fa05d-30 h3,.kb-row-layout-id2072_3fa05d-30 h4,.kb-row-layout-id2072_3fa05d-30 h5,.kb-row-layout-id2072_3fa05d-30 h6{color:var(--global-palette9, #ffffff);}@media all and (max-width: 1024px){.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><section class=\"kb-row-layout-wrap kb-row-layout-id2072_3fa05d-30 alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column2072_161eaf-22 > .kt-inside-inner-col,.kadence-column2072_161eaf-22 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_161eaf-22 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_161eaf-22 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_161eaf-22 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_161eaf-22 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_161eaf-22{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_161eaf-22 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_161eaf-22 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_161eaf-22\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2, .wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2[data-kb-block=\"kb-adv-heading2072_e0096e-b2\"]{text-align:center;font-weight:400;font-style:normal;font-family:var( --global-body-font-family, inherit );}.wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2[data-kb-block=\"kb-adv-heading2072_e0096e-b2\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2[data-kb-block=\"kb-adv-heading2072_e0096e-b2\"] img.kb-inline-image{width:150px;vertical-align:baseline;}<\/style>\n<p class=\"kt-adv-heading2072_e0096e-b2 wp-block-kadence-advancedheading has-theme-palette-3-color has-text-color\" data-kb-block=\"kb-adv-heading2072_e0096e-b2\">Alliant Health Plans values its providers. Please find below helpful resources for all providers servicing AHP\u2019s members.<br>For your convenience, we have made the forms below fillable. To enable your computer to edit the forms, follow these&nbsp;<a href=\"https:\/\/alliantplans.com\/article\/instructions-for-fillable-pdf\/\" data-type=\"article\" data-id=\"4015\">instructions<\/a>.<\/p>\n\n\n<style>.kb-row-layout-wrap.wp-block-kadence-rowlayout.kb-row-layout-id2072_ac3d6d-e4{margin-bottom:var(--global-kb-spacing-sm, 1.5rem);}.kb-row-layout-id2072_ac3d6d-e4 > .kt-row-column-wrap{align-content:center;}:where(.kb-row-layout-id2072_ac3d6d-e4 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:center;}.kb-row-layout-id2072_ac3d6d-e4 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);padding-top:16px;padding-right:30px;padding-bottom:16px;padding-left:30px;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2072_ac3d6d-e4 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2072_ac3d6d-e4 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2072_ac3d6d-e4 > .kt-row-column-wrap{padding-top:5px;padding-right:10px;padding-bottom:5px;padding-left:10px;grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2072_ac3d6d-e4 alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-middle\">\n<style>.kadence-column2072_3b5169-5c > .kt-inside-inner-col{display:flex;}.kadence-column2072_3b5169-5c > .kt-inside-inner-col{border-top:2px solid var(--global-palette6, #718096);border-right:2px solid var(--global-palette6, #718096);border-bottom:2px solid var(--global-palette6, #718096);border-left:2px solid var(--global-palette6, #718096);}.kadence-column2072_3b5169-5c > .kt-inside-inner-col,.kadence-column2072_3b5169-5c > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_3b5169-5c > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_3b5169-5c > .kt-inside-inner-col{flex-direction:row;flex-wrap:wrap;align-items:center;justify-content:space-between;}.kadence-column2072_3b5169-5c > .kt-inside-inner-col > *, .kadence-column2072_3b5169-5c > .kt-inside-inner-col > figure.wp-block-image, .kadence-column2072_3b5169-5c > .kt-inside-inner-col > figure.wp-block-kadence-image{margin-top:0px;margin-bottom:0px;}.kadence-column2072_3b5169-5c > .kt-inside-inner-col > .kb-image-is-ratio-size{flex-grow:1;}.kt-row-column-wrap > .kadence-column2072_3b5169-5c{align-self:center;}.kt-inner-column-height-full:not(.kt-has-1-columns) > .wp-block-kadence-column.kadence-column2072_3b5169-5c{align-self:auto;}.kt-inner-column-height-full:not(.kt-has-1-columns) > .wp-block-kadence-column.kadence-column2072_3b5169-5c > .kt-inside-inner-col{align-items:center;}.kadence-column2072_3b5169-5c > .kt-inside-inner-col{background-color:var(--global-palette8, #F7FAFC);}.kadence-column2072_3b5169-5c > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_3b5169-5c{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_3b5169-5c > .kt-inside-inner-col{border-top:2px solid var(--global-palette6, #718096);border-right:2px solid var(--global-palette6, #718096);border-bottom:2px solid var(--global-palette6, #718096);border-left:2px solid var(--global-palette6, #718096);flex-direction:row;flex-wrap:wrap;align-items:center;justify-content:space-between;}}@media all and (max-width: 1024px){.kt-row-column-wrap > .kadence-column2072_3b5169-5c{align-self:center;}}@media all and (max-width: 1024px){.kt-inner-column-height-full:not(.kt-has-1-columns) > .wp-block-kadence-column.kadence-column2072_3b5169-5c{align-self:auto;}}@media all and (max-width: 1024px){.kt-inner-column-height-full:not(.kt-has-1-columns) > .wp-block-kadence-column.kadence-column2072_3b5169-5c > .kt-inside-inner-col{align-items:center;}}@media all and (min-width: 768px) and (max-width: 1024px){.kadence-column2072_3b5169-5c > .kt-inside-inner-col > *, .kadence-column2072_3b5169-5c > .kt-inside-inner-col > figure.wp-block-image, .kadence-column2072_3b5169-5c > .kt-inside-inner-col > figure.wp-block-kadence-image{margin-top:0px;margin-bottom:0px;}.kadence-column2072_3b5169-5c > .kt-inside-inner-col > .kb-image-is-ratio-size{flex-grow:1;}}@media all and (max-width: 767px){.kadence-column2072_3b5169-5c > .kt-inside-inner-col{border-top:2px solid var(--global-palette6, #718096);border-right:2px solid var(--global-palette6, #718096);border-bottom:2px solid var(--global-palette6, #718096);border-left:2px solid var(--global-palette6, #718096);flex-direction:column;justify-content:center;align-items:stretch;flex-wrap:nowrap;}.kt-row-column-wrap > .kadence-column2072_3b5169-5c{align-self:center;}.kt-inner-column-height-full:not(.kt-has-1-columns) > .wp-block-kadence-column.kadence-column2072_3b5169-5c{align-self:auto;}.kt-inner-column-height-full:not(.kt-has-1-columns) > .wp-block-kadence-column.kadence-column2072_3b5169-5c > .kt-inside-inner-col{flex-direction:column;justify-content:center;}.wp-block-kadence-column.kb-section-dir-horizontal.kadence-column2072_3b5169-5c > .kt-inside-inner-col > .wp-block-kadence-infobox{align-self:unset;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_3b5169-5c kb-section-dir-horizontal kb-section-sm-dir-vertical\"><div class=\"kt-inside-inner-col\"><style>.kb-row-layout-id2072_a3b06e-5a > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2072_a3b06e-5a > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2072_a3b06e-5a > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1440px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var(--global-kb-spacing-sm, 1.5rem);padding-bottom:var(--global-kb-spacing-sm, 1.5rem);grid-template-columns:minmax(0, calc(10% - ((var(--global-kb-gap-md, 2rem) * 1 )\/2)))minmax(0, calc(90% - ((var(--global-kb-gap-md, 2rem) * 1 )\/2)));}.kb-row-layout-id2072_a3b06e-5a > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2072_a3b06e-5a > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr) minmax(0, 2fr);}}@media all and (max-width: 767px){.kb-row-layout-id2072_a3b06e-5a > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2072_a3b06e-5a alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-2-columns kt-row-layout-right-golden kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column2072_8dfc0d-e1 > .kt-inside-inner-col,.kadence-column2072_8dfc0d-e1 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_8dfc0d-e1 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_8dfc0d-e1 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_8dfc0d-e1 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_8dfc0d-e1 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_8dfc0d-e1{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_8dfc0d-e1 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_8dfc0d-e1 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_8dfc0d-e1\"><div class=\"kt-inside-inner-col\"><style>.kt-svg-icons2072_e9d536-44 .kt-svg-item-0 .kb-svg-icon-wrap{color:var(--global-palette4, #2D3748);font-size:50px;}.wp-block-kadence-icon.kt-svg-icons2072_e9d536-44{justify-content:center;}<\/style>\n<div class=\"wp-block-kadence-icon kt-svg-icons kt-svg-icons2072_e9d536-44 alignnone\"><style>.kt-svg-item-2072_832835-10 .kb-svg-icon-wrap, .kt-svg-style-stacked.kt-svg-item-2072_832835-10 .kb-svg-icon-wrap{color:var(--global-palette9, #ffffff);font-size:22px;background:var(--global-palette1, #3182CE);border-color:var(--global-palette1, #3182CE);border-width:2px;border-radius:16%;padding-top:var(--global-kb-spacing-xs, 1rem);padding-right:var(--global-kb-spacing-xs, 1rem);padding-bottom:var(--global-kb-spacing-xs, 1rem);padding-left:var(--global-kb-spacing-xs, 1rem);}.kt-svg-item-2072_832835-10:hover .kb-svg-icon-wrap{background:var(--global-palette1, #3182CE);border-color:var(--global-palette1, #3182CE);}.kt-svg-item-2072_832835-10:hover .kb-svg-icon-wrap{color:var(--global-palette9, #ffffff);}<\/style>\n<div class=\"wp-block-kadence-single-icon kt-svg-style-stacked kt-svg-icon-wrap kt-svg-item-2072_832835-10\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fe_bell\"><svg viewBox=\"0 0 24 24\"  fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M22 17H2a3 3 0 0 0 3-3V9a7 7 0 0 1 14 0v5a3 3 0 0 0 3 3zm-8.27 4a2 2 0 0 1-3.46 0\"\/><\/svg><\/span><\/div>\n<\/div>\n<\/div><\/div>\n\n\n<style>.kadence-column2072_1c42ee-9f > .kt-inside-inner-col,.kadence-column2072_1c42ee-9f > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_1c42ee-9f > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_1c42ee-9f > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_1c42ee-9f > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_1c42ee-9f > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_1c42ee-9f{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_1c42ee-9f > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_1c42ee-9f > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_1c42ee-9f\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_74b918-7e_0, .wp-block-kadence-advancedheading.kt-adv-heading2072_74b918-7e_0[data-kb-block=\"kb-adv-heading2072_74b918-7e_0\"]{font-size:16px;line-height:1.4;font-style:normal;font-family:var( --global-body-font-family, inherit );color:#000000;}.wp-block-kadence-advancedheading.kt-adv-heading2072_74b918-7e_0 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_74b918-7e_0[data-kb-block=\"kb-adv-heading2072_74b918-7e_0\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2072_74b918-7e_0 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2072_74b918-7e_0[data-kb-block=\"kb-adv-heading2072_74b918-7e_0\"] img.kb-inline-image{width:150px;vertical-align:baseline;}<\/style>\n<h2 class=\"kt-adv-heading2072_74b918-7e_0 wp-block-kadence-advancedheading\" data-kb-block=\"kb-adv-heading2072_74b918-7e_0\"><strong>Attention: <\/strong>For all Medical Pharmacy (Buy and Bill) Prior Authorizations and Pharmacy Benefit Prior Authorizations, please follow the link below to the Pharmacy Resources Page.<\/h2>\n\n\n<style>.wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2, .wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2[data-kb-block=\"kb-adv-heading2072_87716f-c2\"]{font-style:normal;font-family:var( --global-heading-font-family, inherit );}.wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2[data-kb-block=\"kb-adv-heading2072_87716f-c2\"]{display:flex;gap:0.25em;align-items:center;}.wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2[data-kb-block=\"kb-adv-heading2072_87716f-c2\"] .kb-adv-heading-icon svg{width:1em;height:1em;}.wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2[data-kb-block=\"kb-adv-heading2072_87716f-c2\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2[data-kb-block=\"kb-adv-heading2072_87716f-c2\"] img.kb-inline-image{width:150px;vertical-align:baseline;}.wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2[data-kb-block=\"kb-adv-heading2072_87716f-c2\"] a, a.kb-advanced-heading-link.kt-adv-heading-link2072_87716f-c2{text-decoration:none;}.wp-block-kadence-advancedheading.kt-adv-heading2072_87716f-c2[data-kb-block=\"kb-adv-heading2072_87716f-c2\"] a:hover, a.kb-advanced-heading-link.kt-adv-heading-link2072_87716f-c2:hover{text-decoration:underline;}<\/style><a class=\"kb-advanced-heading-link kt-adv-heading-link2072_87716f-c2 hls-hover_underline\" href=\"https:\/\/alliantplans.com\/providers\/pharmacy-resources\/\"><p class=\"kt-adv-heading2072_87716f-c2 wp-block-kadence-advancedheading kt-adv-heading-has-icon hls-hover_underline has-theme-palette3-color has-text-color\" data-kb-block=\"kb-adv-heading2072_87716f-c2\"><span class=\"kb-svg-icon-wrap kb-adv-heading-icon kb-svg-icon-fe_arrowRight kb-adv-heading-icon-side-left\"><svg viewBox=\"0 0 24 24\"  fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><line x1=\"5\" y1=\"12\" x2=\"19\" y2=\"12\"\/><polyline points=\"12 5 19 12 12 19\"\/><\/svg><\/span><span class=\"kb-adv-text-inner\">Pharmacy Resources Page<\/span><\/p><\/a><\/div><\/div>\n\n<\/div><\/div><\/div><\/div>\n\n<\/div><\/div>\n\n<style>.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1440px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var(--global-kb-spacing-sm, 1.5rem);padding-bottom:var(--global-kb-spacing-sm, 1.5rem);grid-template-columns:repeat(2, minmax(0, 1fr));}.kb-row-layout-id2072_254d39-70 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap{grid-template-columns:repeat(2, minmax(0, 1fr));}}@media all and (max-width: 767px){.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2072_254d39-70 alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-2-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column2072_3c6161-8a > .kt-inside-inner-col,.kadence-column2072_3c6161-8a > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_3c6161-8a > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_3c6161-8a > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_3c6161-8a > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_3c6161-8a > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_3c6161-8a{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_3c6161-8a > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_3c6161-8a > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_3c6161-8a\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f, .wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f[data-kb-block=\"kb-adv-heading2072_b187d4-7f\"]{padding-top:0px;padding-bottom:var(--global-kb-spacing-xxs, 0.5rem);line-height:1.8;font-style:normal;}.wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f[data-kb-block=\"kb-adv-heading2072_b187d4-7f\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f[data-kb-block=\"kb-adv-heading2072_b187d4-7f\"] img.kb-inline-image{width:150px;vertical-align:baseline;}<\/style>\n<h2 class=\"kt-adv-heading2072_b187d4-7f wp-block-kadence-advancedheading has-theme-palette-1-color has-text-color\" data-kb-block=\"kb-adv-heading2072_b187d4-7f\">General Resources<\/h2>\n\n\n<style>.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf:not(.this-stops-third-party-issues){margin-top:0px;margin-bottom:0px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list:not(.this-prevents-issues):not(.this-stops-third-party-issues):not(.tijsloc){margin-top:0px;margin-right:0px;margin-bottom:var(--global-kb-spacing-sm, 1.5rem);margin-left:0px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list{grid-row-gap:5px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf .kb-svg-icon-wrap{font-size:18px;color:#fd7c7c;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap .kt-svg-icon-list-single{margin-right:10px;}.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap, .kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap a{font-size:18px;}.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .kt-svg-icon-list-level-0 .kt-svg-icon-list-single svg{font-size:20px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf .wp-block-kadence-listitem a{text-decoration:none;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf .wp-block-kadence-listitem a:hover{text-decoration:underline;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .wp-block-kadence-listitem a{color:var(--global-palette3, #1A202C);}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .wp-block-kadence-listitem a:hover{color:var(--global-palette2, #2B6CB0);}<\/style>\n<div class=\"wp-block-kadence-iconlist kt-svg-icon-list-items kt-svg-icon-list-items2072_85a5d0-bf kt-svg-icon-list-columns-1 alignnone kt-list-icon-aligntop\"><ul class=\"kt-svg-icon-list\"><style>.kt-svg-icon-list-item-2072_898991-63 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_898991-63\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/provider-appeal-form\/\" data-type=\"document\" data-id=\"3784\">Provider Appeal Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_be8998-8e .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_be8998-8e\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/member-accident-injury-form\/\" data-type=\"document\" data-id=\"2912\">Member Accident Injury Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_cab7ff-6e .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_cab7ff-6e\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/commercial-transplant-facilities-adult\/\">Commercial Transplant Facilities (Adult)<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_d56df0-91 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_d56df0-91\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/commercial-transplant-facilities-pediatric\/\">Commercial Transplant Facilities (Pediatric)<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_08c6ab-bf .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_08c6ab-bf\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/provider-update-form\/\" data-type=\"document\" data-id=\"3821\">Provider Update Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_08c8ef-3a .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_08c8ef-3a\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/alliant-network-provider-search-instructions\/\" data-type=\"document\" data-id=\"3031\">Alliant Network Provider Search Instructions<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_9c11f2-12 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_9c11f2-12\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/recoupment-processing-exception-request\/\">Recoupment Processing Exception Request<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_9082b0-c9 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_9082b0-c9\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/authorization-for-the-release-of-protected-health-information-phi\/\" data-type=\"document\" data-id=\"3838\">Authorization for the Release of Protected Health Information (PHI)<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_b45b0c-54 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_b45b0c-54\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/alliant-health-plans-quick-reference-guide\/\" data-type=\"document\" data-id=\"3843\">Alliant Health Plans Quick Reference Guide<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_7a93dc-d7 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_7a93dc-d7\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/out-of-network-claim-payment-dispute-form\/\" data-type=\"document\" data-id=\"3848\">Out of Network Claim Payment Dispute Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_640727-82 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_640727-82\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a data-type=\"document\" data-id=\"3852\" href=\"https:\/\/alliantplans.com\/document\/provider-request-for-out-of-network-mac-payment\/\">Provider Request for Out of Network MAC Payment<\/a><\/span><\/li>\n<\/ul><\/div>\n\n\n\n<p><\/p>\n<\/div><\/div>\n\n\n<style>.kadence-column2072_1eab34-03 > .kt-inside-inner-col,.kadence-column2072_1eab34-03 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_1eab34-03 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_1eab34-03 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_1eab34-03 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_1eab34-03 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_1eab34-03{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_1eab34-03 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_1eab34-03 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_1eab34-03\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_d4e512-37, .wp-block-kadence-advancedheading.kt-adv-heading2072_d4e512-37[data-kb-block=\"kb-adv-heading2072_d4e512-37\"]{padding-top:0px;padding-bottom:var(--global-kb-spacing-xxs, 0.5rem);line-height:1.8;font-style:normal;}.wp-block-kadence-advancedheading.kt-adv-heading2072_d4e512-37 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_d4e512-37[data-kb-block=\"kb-adv-heading2072_d4e512-37\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2072_d4e512-37 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2072_d4e512-37[data-kb-block=\"kb-adv-heading2072_d4e512-37\"] img.kb-inline-image{width:150px;vertical-align:baseline;}<\/style>\n<h2 class=\"kt-adv-heading2072_d4e512-37 wp-block-kadence-advancedheading has-theme-palette-1-color has-text-color\" data-kb-block=\"kb-adv-heading2072_d4e512-37\">Medical Resources<\/h2>\n\n\n<style>.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61:not(.this-stops-third-party-issues){margin-top:0px;margin-bottom:0px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61 ul.kt-svg-icon-list:not(.this-prevents-issues):not(.this-stops-third-party-issues):not(.tijsloc){margin-top:0px;margin-right:0px;margin-bottom:var(--global-kb-spacing-sm, 1.5rem);margin-left:0px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61 ul.kt-svg-icon-list{grid-row-gap:5px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61 .kb-svg-icon-wrap{font-size:18px;color:#fd7c7c;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61 ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap .kt-svg-icon-list-single{margin-right:10px;}.kt-svg-icon-list-items2072_6b07b5-61 ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap, .kt-svg-icon-list-items2072_6b07b5-61 ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap a{font-size:18px;}.kt-svg-icon-list-items2072_6b07b5-61 ul.kt-svg-icon-list .kt-svg-icon-list-level-0 .kt-svg-icon-list-single svg{font-size:20px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61 .wp-block-kadence-listitem a{text-decoration:none;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61 .wp-block-kadence-listitem a:hover{text-decoration:underline;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61 ul.kt-svg-icon-list .wp-block-kadence-listitem a{color:var(--global-palette3, #1A202C);}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_6b07b5-61 ul.kt-svg-icon-list .wp-block-kadence-listitem a:hover{color:var(--global-palette2, #2B6CB0);}<\/style>\n<div class=\"wp-block-kadence-iconlist kt-svg-icon-list-items kt-svg-icon-list-items2072_6b07b5-61 kt-svg-icon-list-columns-1 alignnone kt-list-icon-aligntop\"><ul class=\"kt-svg-icon-list\"><style>.kt-svg-icon-list-item-2072_0758ee-f2 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_0758ee-f2\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/prior-authorization-request-form\/\" data-type=\"document\" data-id=\"3860\">Prior Authorization Request Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_5b9ef9-63 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_5b9ef9-63\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/primary-care-physician-resource-depression\/\" data-type=\"document\" data-id=\"3864\">Primary Care Physician Resource: Depression Informational Presentation and Survey<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_1d3071-fd .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_1d3071-fd\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/procedures-requiring-prior-authorization-2\/\" data-type=\"document\" data-id=\"3872\">Procedures Requiring Prior Authorization<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_9aefa4-02 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_9aefa4-02\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a data-type=\"document\" data-id=\"3878\" href=\"https:\/\/alliantplans.com\/document\/mohs-certifications-statement\/\">Mohs Certifications Statement<\/a><\/span><\/li>\n<\/ul><\/div>\n<\/div><\/div>\n\n<\/div><\/div><\/div><\/div>\n\n\n<style>.kadence-column2072_95695f-05 > .kt-inside-inner-col,.kadence-column2072_95695f-05 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_95695f-05 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_95695f-05 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_95695f-05 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_95695f-05 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_95695f-05{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_95695f-05 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_95695f-05 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_95695f-05\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9, .wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"]{text-align:center;font-style:normal;}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] img.kb-inline-image{width:150px;vertical-align:baseline;}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] a, .kt-adv-heading-link2072_53e924-a9, .kt-adv-heading-link2072_53e924-a9 .kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"]{color:var(--global-palette3, #1A202C);}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] a:hover, .kt-adv-heading-link2072_53e924-a9:hover, .kt-adv-heading-link2072_53e924-a9:hover .kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"]{color:var(--global-palette2, #2B6CB0);}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] a, a.kb-advanced-heading-link.kt-adv-heading-link2072_53e924-a9{text-decoration:none;}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] a:hover, a.kb-advanced-heading-link.kt-adv-heading-link2072_53e924-a9:hover{text-decoration:underline;}<\/style>\n<p class=\"kt-adv-heading2072_53e924-a9 wp-block-kadence-advancedheading has-theme-palette-3-color has-text-color hls-hover_underline\" data-kb-block=\"kb-adv-heading2072_53e924-a9\">For additional information, please contact Provider Relations at<mark class=\"kt-highlight\"><a href=\"tel:8006648480\"> 800-664-8480<\/a><\/mark> or&nbsp;<a>ProviderRelations@alliantplans.com<\/a>.<\/p>\n<\/div><\/div>\n\n<\/div><\/section>","protected":false},"excerpt":{"rendered":"<p>Provider Forms and Documents Alliant Health Plans values its providers. Please find below helpful resources for all providers servicing AHP\u2019s members.For your convenience, we have made the forms below fillable. To enable your computer to edit the forms, follow these&nbsp;instructions. Attention: For all Medical Pharmacy (Buy and Bill) Prior Authorizations and Pharmacy Benefit Prior Authorizations,&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":42,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_kadence_starter_templates_imported_post":false,"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","_jet_sm_ready_style":"","_jet_sm_style":"","_jet_sm_controls_values":"","_jet_sm_fonts_collection":"","_jet_sm_fonts_links":"","footnotes":""},"class_list":["post-2072","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Provider Forms and Documents - Alliant Health Plans<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alliantplans.com\/es\/providers\/provider-forms-and-documents\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Provider Forms and Documents\" \/>\n<meta property=\"og:description\" content=\"Provider Forms and Documents Alliant Health Plans values its providers. Please find below helpful resources for all providers servicing AHP\u2019s members.For your convenience, we have made the forms below fillable. To enable your computer to edit the forms, follow these&nbsp;instructions. 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