Provider Resources

 Program Resources

• Assisted Outpatient Treatment Handbook

Beginning in September 2025 Member Registration will be available as part of the member registration process in Availity.  Navigate to the Availity login portal to complete Problem Gambling forms.

Client Registration

• Client Registration Form (PDF)
• Client / Member Registration Guide (PDF)

Clinical Forms

• Facility Participating Medicare Template (PDF)
• Covered Services Authorization Required (PDF)
• Authorization Reference Guide (PDF)
• Critical Incident Report form (PDF)
• Critical Incident Reporting Procedures (PDF)
• Crisis Alert (PDF)
• Provider Dispute Resolution Request Form (PDF)
• Provider Dispute Resolution FAQ (PDF)

Handbook – WA Supplement

• Washington State ASO Provider Handbook Addendum (PDF)
• Change Healthcare’s InterQual® Behavioral Health Medical Necessity Criteria 
• Monthly Exclusionary OIG/SAM Attestation (PDF/Fillable)

ProviderConnect

• ProviderConnect Guides and Tutorials
• Login or register with ProviderConnect, an online tool that allows you to submit and check claims status, check member eligibility, update your provider profile, request inpatient and outpatient authorizations, and more. ProviderConnect is easy to use, secure and available 24/7.
   

  Login Register Demo