Forms & Resources

Resources

• Specialist Roster (updated 12/15/2011): Excel

General Forms

• Treatment Authorization (TAR) Form (Revised 2/2009): Word (Fillable) | PDF
• Referral Authorization Form (Revised 2/2009): Word (Fillable) | PDF
• Specialist Extension Form (Revised 2/2009): Word (Fillable) | PDF

Claims Dispute Forms

• Provider Dispute Resolution Request (PDRR) Form: Word | PDF
• Provider Dispute Resolution Request (PDRR) Instructions: Word | PDF

Other Forms

• NEMS NPI Registration Form: Word | PDF