Provider forms

Page last updated on: 6/20/25

Find general Priority Health forms below.

Authorization forms

Go to the Drug authorization & billing page or the Authorizations page.

Behavioral health forms

Go to this page for all behavioral health forms. 

Prior notification form

Genetics medical policy prior notification form regarding counseling, testing and screening.

Submit provider changes through prism.

Change Individual Provider or Organization

Individual provider enrollments and provider organization enrollments need to be submitted through prism.

New Individual Provider Enrollment

New Organizational Provider Enrollment 

  • Patient acknowledgment of financial responsibility - non-Medicare only - 06/2014
  • Notice of Medicare non-coverage - Medicare Advantage patients only, for use by Skilled Nursing Facilities (SNF) and Home Health Care agencies - 04/2025
    The NOMNC must remain two pages and cannot be condensed into one page nor can information be moved from page 1 or page 2 to accommodate large logos or address headers. Logos and addresses can only appear at the top of the form. CMS provides this information in the NOMNC form instructions found on FFS ED Notices.