Provider Information
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Provider Forms

 

PDF DownloadNew Provider Application

PDF DownloadProvider Update Form

 

Authorization Forms

PDF DownloadPrior Authorization Form - Cox II

PDF DownloadPrior Authorization Form - Non-Sedating Antihistamines

PDF DownloadPrior Authorization Form - Proton Pump Inibitor

PDF DownloadPrecertification Documentation Form

 

Provider Checklists

PDF DownloadRequired Authorization List

PDF DownloadAdult, Childhood & Prenatal Preventive Health Guidelines

PDF DownloadKentucky Terms and Conditions

 

WHP Provider Web Portal

PDF DownloadWeb Portal Request Form

PDF DownloadSuper User Instructions

PDF DownloadHow to Register as a Standard User

 

Fraud, Waste and Abuse (FWA)

PDF DownloadFraud, Waste and Abuse (FWA) Training Materials

PDF DownloadFraud, Waste and Abuse (FWA) Attestation Form

 

Welborn Health Plans
Welborn Health Plans

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