Document Library

Authorization form

This Prenatal Genetic Risk Assessment Form will help providers assess genetic risks during routine prenatal care.

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.