At RMHP, we want to make sure you have access to the resources you need to provide your patients with the care they deserve. Have you recently moved office locations and you're looking to update your information? Do you need to submit a prior authorization request for your patient? We've included the common forms and resources you need most in one place for your convenience.
- Online Provider New User Registration
- Referral to case/disease Management Form
- Provider Information Update/Change Form
- Credentialing Packet
- Claims Action Request (CAR) Form
- Provider Dispute Resolution Form
- Injury Information Form
- Fax Cover Sheet (for submitting records)
- 1500 Health Insurance Claim Form
- UB-04 Claim Form
- Check Refund Form
- Medicare Billing Guide
- Prescription Reimbursement Form
- Brand Name Drug Request Form
- RMHP RAE Orientation Guide
- RMHP RAE Behavioral Health Guide
- EDI Transaction Request Form
- ERA Enrollment Form
- Commercial Formulary Exception Request Form
- Electronic Commerical & Medicaid Preauthorization Request Form
- Printable Commercial Preauthorization Forms
- Printable Medicaid Preauthorization Forms
- Printable Medicare Part B Preauthorization Forms
- UM Preauthorization Form English | Spanish
- Home Health Authorization Form
- DME Authorization Form
- BIPAP/CPAP Questionnaire
- Waiver or Liability/Advanced Beneficiary Notice Form
- Notice of Medicare Provider Non-Coverage
- Med178 - Medicaid Sterilization Consent Form
- 2018 Commercial Payer Sheet
- 2018 Medicaid Payer Sheet