Showing 31-40 results of 66 total
Documents

Designation of Personal Representative Form (pdf)

Allowing disclosure of protected health information, this form needs to be filled out if a member would like someone to act on their behalf.
Documents

Provider Dispute Resolution (pdf)

The Provider Dispute Resolution Form allows providers to request resolution for disputes concerning payments.
Documents

Statement of Nondiscrimination & Language Access (pdf)

The Statement of Nondiscrimination & Language Access outlines Scripps Health Plan’s policy regarding discrimination and language accessibility options
Documents

Provider Directory (pdf)

In this directory, you’ll find lists of in-network specialists, primary care providers, hospitals, surgery centers, urgent care centers and imaging locations.
Documents

Transition of Care Form (pdf)

The Transition of Care Request Form allows members to request coverage for care from an out-of-network doctor willing to accept Scripps Health Plan contracted rates or certain other providers.
Documents

Cerecons New User Application (pdf)

The Information Systems Access Request Form allows affiliated providers to request remote access to Scripps Health Plan computer and information systems.
Documents

Authorization for Release of Protected Health Information (pdf)

Fill out Scripps Health Plan's Authorization of Protected Health Information (PHI) form to have your health records released to specific companies or individuals.
Documents

Confidential Communication Request Form (pdf)

This form allows members to request Scripps Health Plan contact them at an address or telephone number different from what is in their personal records.
Documents

Continuity of Care (pdf)

The Continuity of Care Policy describes how ongoing care is affected by a provider’s contract termination or when a member enrolls when undergoing care.
Documents

Employee Enrollment Form (pdf)

The Employee Enrollment Form is completed by employers or employees who want to enroll in or make changes to Scripps Health Plan coverage.