Publications

A revised version of the Provider Operations Manual has been posted for review. It will become effective on December 16, 2017. Access the review version.

You can scroll through our most commonly requested publications below, including the Provider Operations Manual, or download them using the link below each preview.

Finance and claim resources, as well as other useful forms and documents, are available for download further down the page.

Use the convenient table of contents to the right to navigate to your destination.

Finance and Claims Forms for Providers

These finance and claim resources give providers access to the most commonly used authorization forms, claim forms, request forms and many more.

Other Forms and Documents for Providers

Members of the Alliance Provider Network can find other necessary forms, documents and other resources below.

AlphaMCS Access Request
B3 IPRS DD Support Plan
Back-Up Staffing Report Form
Certification of Need Medicaid Inpatient Psychiatric Service Under Age 21
Client Transfer Tracking Form
DASH-Home Again Application
Emergency Relocation Form
Form QM11
Guidelines for Implementing Core Rules
HIPAA Request for Accounting of Disclosure
HIPAA Request for Alternative Means of Communication
HIPAA Request for Restrictions on Use and Disclosure
HIPAA Request to Review Amend Record
Innovations Periodic Codes Service Request Additon
Innovations Quarterly Progress Summary
Innovations Quarterly Progress Summary Instructions and Due Dates
ISP Short Term Goals Documentation
Level of Care Eligibility Determination Tool
Licensed Facility Rule Waiver Request Protocol
LME Consumer Admission and Discharge Form
Notice of Change
Payment Form
Provider Application Request
Provider Assignments to Credentialing Team
Provider Directory Update Form
Provider Request for Reconsideration of an Action Form
Provider Self Audit Submission Instructions
Provider Self Audit Templates
Record Destruction Log
Record Storage Log IPRS
Record Storage Log Medicaid
Relative as Provider Application Part A
Relative as Provider Application Part A and D Addendum
Relative as Provider Application Part A-1 (effective 11/1/16)
Request to Add Clinician
Sample ISP Short Term Goals Implementation
Universal Therapeutic Foster Care Application
Universal Treatment Foster Care and Residential Services Application
Unlicensed AFL Site Enrollment Request
Wage Complaint


Page last modified: November 16, 2017