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Access key forms for authorizations, claims, pharmacy and more.

Appeals and Grievances


A copy of the IFSP must be attached to the PA Request.

Transplant Authorization Request Form

Behavioral Health

Behavioral Health Service Request Form: Applied Behavior Analysis (ABA) For Autism Spectrum Disorder

South Carolina Department of Mental Health CMHC Treatment Review & Authorization Request


Drug Prior Authorization Requests Supplied by the Physician/Facility

Other Provider Forms

Use this form to request a PCP change for a member.

Refund Check Information Sheet* (RCIS)


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Last Updated On: 2/4/2019