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Forms for providers
Commonly used forms for doing business with HealthPartners
Claims
- Claim Adjustment Requests - online
Add new data or change originally submitted data on a claim - Claim Appeal Requests - online
Reconsideration of originally submitted claim data - Claim Attachment Submissions - online
- Claim Correspondence - online
Contracting, Credentialing and Enrollment
Forms for submitting prior authorization requests
Sign in to check the status of your prior authorization request and select Authorizations and referrals from your menu.Fillable forms work best when using the Adobe Acrobat Reader DC application. Visit get.Adobe.com/reader for more information.
- Airway Clearance System/Chest Compression Generator System review
- CPM review
- Crisis Residential Treatment Service review
- DHS Nursing Facility (NF) Communication Form DHS-4461
- Durable Medical Equipment (DME) review
- Enteral Nutrition (Formula) review
- Enteral Nutrition (Formula) review - Minnesota Health Care Programs
- Fixed Wing Air Ambulance Transportation review
- Genetic Testing review
- Hip Arthroplasty review
- Home Health Care review
- Hospital Bed review
- In-Network Benefit review
- Knee Arthroplasty review
- Lift Chair review
- Medical-Dental Procedures - Accidental Dental review
- Medical-Dental Procedures - Facility-General Anesthesia review
- Medical-Dental Procedures - Oral Surgery for Dental Conditions review
- Medical-Dental Procedures - Orthognathic Surgery review
- Medical-Dental Procedures - Surgical Intervention for TMD review
- Medical gender services/surgery review
- Mental Health Partial Hospitalization review
- Mental Health Residential Treatment Services review
- PCA Assessment review
- PCA Change of Vendor review
- Pneumatic Compression Devices review
- Procedures review
- Radiofrequency Ablation Spine review
- Sacroiliac (SI) injections to treat SI joint pain review
- Site of Service-Attended Polysomnography for Evaluation of OSA review
- Skilled Nursing Facility Admission review
- Skilled Nursing Facility Continued Stay review
- Specialty Mattress Gp I or Gp II review
- Spinal Cord Stimulator review
- Spinal Fusion-Lumbar AND/OR Spinal Decompression Surgeries review
- Synagis (RSV) Season review
- Substance Use Disorder Services review
- Transcranial Magnetic Stimulation review
- Transplant Prior Notification review
- UnityPoint In-Network review
- Upper airway, hypoglossal nerve stimulation therapy for obstructive sleep apnea review
- Varicose vein procedures of the lower extremities review
- Vertebral augmentation(percutaneous vertebroplasty and kyphoplasty)review
- Weight Loss Surgery review
- Wheelchair review