Provider Forms: 

Welcome!  Providers may use the Precertification/Referral Request Form to initiate the pre-certification process.  Please complete the form and fax the requested information to (607) 648-3444.  If you have any questions, please feel free to call us at 1 (800) 541-7403 and press 1.  Any attendant should be able to answer your questions.  We look forward to working with you.


Precertification Form





We can accomplish almost anything within our ability if we but think that we can! - George Matthew AdamsCMDM