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This prior authorization form is for providers to request services for members under Dean Health Plan.

To decline health insurance coverage

This EDI Setup Form 837 Claim will help a provider establish a new or change an existing direct connection for claim submission with Dean Health Plan.

This EDI Setup Form 277CA Claim Acknowledgment will help a provider establish a new or change an existing direct connection for claim acknowledgment with Dean Health Plan.

This EDI Setup Form 276/277 Claim Status will help a provider establish a new or change an existing direct connection for claim status with Dean Health Plan.

This EDI Setup Form 270 Eligibility will help a provider establish a new direct connection or change an existing direct connection for eligibility with Dean Health Plan.