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Alliant Health Plans

Provider
Forms and Documents

Alliant Health Plans values its providers. Please find below helpful resources for all providers servicing AHP’s members.
For your convenience, we have made the forms below fillable. To enable your computer to edit the forms, follow these instructions.

General Resources

  • Provider Appeal Form
  • Member Accident Injury Form
  • Members/Providers: Alliant Transplant Network
  • Provider Update Form
  • Alliant Network Provider Search Instructions
  • Recoupment Processing Exception Request
  • Authorization for the Release of Protected Health Information (PHI)
  • Alliant Health Plans Quick Reference Guide
  • Out of Network Claim Payment Dispute Form
  • Provider Request for Out of Network MAC Payment

Medical Resources

  • Prior Authorization Request Form
  • Primary Care Physician Resource: Depression Informational Presentation and Survey
  • Procedures Requiring Prior Authorization
  • Mohs Certifications Statement
  • Pharmacy Resources

For additional information, please contact Provider Relations at 800-664-8480 or ProviderRelations@alliantplans.com.

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