Forms
- Empower Prior Authorization Form for Behavioral Health or Developmental Disability Providers
- Empower Prior Authorization Form for Medical Services
- Outpatient Information for Residential Request
- Quick Reference Guide for Continued Stay Requests
- Certification of Need
Incident Reporting Forms
Resources
Empower Resources
- Provider Portal User Guide
- Quick Reference Guide General Information
- Quick Reference Guide Services Requiring Prior Authorization
Claims Resources
- Change Healthcare X12 Institutional & Professional Claims (837) Companion Guide
- Tips for Completing the UB04 (CMS-1450) claim form
- Tips for Completing the CMS-1500 claim form
- Instamed ERA/EFT FAQ
PASSE Resources