MHS WIForms
Phone Numbers
Member Services
(888) 713-6180
TDD/TTY: (800) 446-6136Provider Inquiry Line
(800) 222-9831
8 a.m. to 5 p.m.
Monday - FridayProvider Portal
To enter our secure portal click on the login button. If you need a username and password click on the register button.
Resources
Provider Manuals
Forms
Administrative & Billing
Latest Provider Updates
Patient Health Education
Newsletters
Reference & Gudies
Helpful Links
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Medical Forms
- Abortion – Patient Statement (PDF)
- Acknowledgement of Receipt of Hysterectomy Patient Form (PDF)
- Care Coordination Referral Request (PDF)
- Case Management Services – Referral Form (PDF)
- Durable Medical Equipment (DME) Referral Request (PDF)
- Home Health Services Prior Authorization Request (PDF)
- Neuropsyche Test Authorization Request (PDF)
- New Provider Form 4-2012
- Pain Management Referral Request (PDF)
- Periodontist Referral Request (PDF)
- Pregnancy Notification Form (PDF)
- Prior Authorization – Fax Cover Letter (PDF)
- Respiratory Program Referral Request (PDF)
- Sterilization – Consent and Instructions (PDF)
- Surgical Authorization Request (PDF)
- Therapy Referral Request (PDF)
Pharmacy