Showing 61-80 results of 114 total
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

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

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.
Documents

Member Claim Reimbursement Form (pdf)

The Member Claim Reimbursement Form is for direct reimbursement to members for covered medical benefits under Scripps Health Plan.
Documents

Member Welcome Guide (pdf)

The Member Welcome Guide is intended to assist new Scripps Health Plan members with questions they may have regarding access to health care services.
Documents

Network Medical Group Contacts (pdf)

Find a list of medical groups that are part of the Scripps Health Plan network along with addresses, email addresses and phone numbers for each.
Documents

Notice of Privacy Practices (pdf)

The Notice of Privacy Practices describes how medical information about you may be used and disclosed, and how you can access this information.
Documents

Prior Authorization Guide (pdf)

The Prior Authorization Guide identifies services that require approval or authorization before members can receive them.
Documents

Provider Operations Manual (pdf)

The Scripps Health Plan Provider Operations Manual contains key contacts within the health plan and other information designed to help providers navigate the plan.
Documents

Scripps Care Link Form (pdf)

Scripps Care Link Access Request Form should be completed by Scripps Health Plan affiliated providers who need access to data from Scripps information systems.
Documents

Coordination of Benefits Form (pdf)

The Coordination of Benefits (COB) form is used to gather information about whether members or their dependents are covered under more than one health plan.
Documents

Continuity of Care Request Form (pdf)

Continuity of Care Request Form to provide continuity of care for new enrollees who are undergoing an Active Course of Treatment from a nonparticipating provider.
Documents

Evidence of Coverage (pdf)

This is a summary benefit description for Scripps Health Plan, which briefly describes your coverage, followed by comprehensive benefit descriptions.
Documents

Summary of Benefits and Coverage (pdf)

Learn more about the Summary of Benefits and Coverage, including what the plan covers and what you pay for covered services.
Documents

Prescription Drug Prior Authorization Request (pdf)

Prescription drug prior authorization request form supports the prior authorization or step-therapy exception requests.
Documents

Provider Dispute Resolution Form (pdf)

The provider dispute resolution form provides space for the member to give supporting information in regards to their dispute.