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• Facility Information Form 1021 fillable

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• Home

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• H3664 ProvInfo26 C PTHP Provider Information form FILLABLE

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• Description of Behavioral Health Services

  Inpatient Care (Hospital-Based) This is the highest level of mental health care. It happens in a hospital setting and is for people in serious crisis, such as: At risk of harming themselves or others. Unable to care for basic needs (eating, hygiene). No safe support system at home. What to expect: 24/7 care from psychiatrists, nurses, and…

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• Generic Incentive Program

  This program assists members with transitioning to a generic equivalent for certain medications when clinically appropriate. An incentive may reduce member cost share. This cost-share adjustment is based on brand name manufacturer assistance programs. Please call AultCare Customer Service at 330-363-6360 or 1-800-344-8858 (TTY 711) for any questions regarding this…

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• Mail Service Provider Fax Form AultCare

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• 2024 Marketpalce Managed Formulary

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• Health Care Coverage Forms For Annuitants FEHB AultCare

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• 7458 21 EFT Authorization Form

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• Designation of Authorized Representitive Form

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