• Facebook
  • Instagram
  • Twitter
  • YouTube
  • Pinterest
  • EnglishEnglish
  • EspañolEspañol
Alliant Health Plans
  • SHOP HEALTH PLANS
  • MEMBERS
  • EMPLOYERS
  • BROKERS
  • PROVIDERS
  • COVID-19 UPDATE
  • LOG IN
    • MEMBERS
    • EMPLOYERS
    • BROKERS
    • PROVIDERS
      • Provider Portal
  • FIND A PROVIDER
    • Provider Network
    • In-Network Pharmacy
Select Page
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
Auto Pay Agreement
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
For additional information, please contact Provider Relations at 800-664-8480 or providerrelations@alliantplans.com.
Copyright 2016. Alliant Health Plans, Inc.
Contact Us About Us Privacy Policy Notice of Privacy Practice Disclaimer Machine Readable Data Site Map

Alliant Health Plans and AdventHealth Gordon, AdventHealth Murray, AdventHealth Gordon Home Care and AdventHealth Medical Group systems have reached an agreement. These entities will remain in Alliant’s Network, with no break in coverage. 

Cancel
Okay
  • Member News

    More

    Click the links below to review the full notice.

«
»