Providers Forms and Documents | 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

Auto Pay Agreement

Alliant Network Provider Search Instructions

Alliant Network Provider Search Instructions (Spanish)

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

Nurse Practitioner Attestation Form

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.