Forms and resources for providers
- DME Precertification Additional Code Form
- DME Precertification Form
- DME Authorization Change Form
- DME Re-Certification Form
- Erythropoietin Stimulating Agents (ESA) Request Form
- Formulary Exception/Prior Authorization Request Form
- Geisinger Gold and Medicare Vaccine Coverage
- Geisinger Gold Nonpar Provider Appeal Process Form
- Geisinger Gold Well Visit Incentive Form
- Hepatitis C Virus Direct-Acting Antivirals Prior Authorization Request Form
- Home Health Precertification Form
- Inpatient Admission Review Form
- Inpatient Planned Procedure Precertification Form
- Inpatient Rehabilitation Precertification Form
- Inpatient Update Review Form
- LA Atypical Antipsychotic Request Form
- Medical Benefit Outpatient Drug Authorization Form
- Newborn Information Form
- NOMNC-Sample Instructions
- Non-Emergent Transport Form
- Opioid Cumulative Morphine Equivalent Dose (MED) Prior Authorization Form - For Medicare
- Opioid Use Prior Auth Form
- Outpatient Radiology Notification List
- Outpatient Radiology Prior Authorization Form
- Outpatient Rehabilitation Therapy Services Request Form
- Outpatient Prior Authorization Form
- Prior Authorization List
- SNF Concurrent Review Form
- SNF Discharge Planning Notification Form
- SNF Precertification Form
- Subutex®/Suboxone® Prior Authorization Request Form
- ≤ 17 Years Old Antipsychotic Authorization Request Form
Specialty vendor drug program
Learn more about Geisinger Health Plan.
Interested in joining our network?
We're committed to helping you deliver the best healthcare to patients and members.
Questions? Contact us
If you have questions or need more information, contact Geisinger Health Plan.
Terms and conditions
View GHP’s terms and conditions.