Documents & Forms

Holy Redeemer Preferred Network Directory

HMO/POS Network Quick Reference Guide

PPO Network Quick Reference Guide

Provider Manual - QualCare

Provider Manual - Qual-Lynx

Continuity of Care Treatment-in-Progress Form

FSA Dependent Care Claim Form

FSA Health Care Claim Form

Healthy Life Styles Claim Form

HRINJ Liquidation Effective 2/3/17

Medical Services Claim Form

RX Claim Form

Vision Claim Form

Qualcare Coordination of Benefits Form

Acupuncture Precertification Form

Chiropractic Pre-Certification

Clean Claim Definition

Diagnostic Testing Pre-Certification

Elective Surgery Foot and Lower Leg Pre-Certification

Home Care Precertification Form

Inpatient Pre-Certification

Maternity Pre-Certification

Physical Therapy Pre-Certification Form Additional Visits/Lower Extremity

Physical Therapy Pre-Certification Form Additional Visits/Spinal

Physical Therapy Pre-Certification Form Additional Visits/Upper Extremity

Physical Therapy Pre-Certification Form Initial/Lower Extremity

Physical Therapy Pre-Certification Form Initial/Spinal

Physical Therapy Pre-Certification Form Initial/Upper Extremity

Pre-Certification Request for IV Therapy

Same Day Surgery Pre-Certification