{"id":2072,"date":"2023-11-16T18:18:17","date_gmt":"2023-11-16T18:18:17","guid":{"rendered":"https:\/\/alliantplans.com\/?page_id=2072"},"modified":"2025-10-03T11:04:02","modified_gmt":"2025-10-03T15:04:02","slug":"provider-forms-and-documents","status":"publish","type":"page","link":"https:\/\/alliantplans.com\/providers\/provider-forms-and-documents\/","title":{"rendered":"Provider Forms and Documents"},"content":{"rendered":"<style>.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1440px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var(--global-kb-spacing-xxl, 5rem);padding-bottom:var(--global-kb-spacing-xxl, 5rem);grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2072_a24b52-b6 > .kt-row-layout-overlay{opacity:0.10;}@media all and (max-width: 1024px){.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2072_a24b52-b6 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2072_a24b52-b6 alignfull has-theme-palette1-background-color kt-row-has-bg wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column2072_f5db25-f7 > .kt-inside-inner-col,.kadence-column2072_f5db25-f7 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_f5db25-f7 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_f5db25-f7 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_f5db25-f7 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_f5db25-f7 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_f5db25-f7{text-align:left;}.kadence-column2072_f5db25-f7{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_f5db25-f7 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_f5db25-f7 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_f5db25-f7 kb-section-dir-vertical inner-column-1\"><div class=\"kt-inside-inner-col\"><style>.kb-row-layout-id2072_eca2ef-1e > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2072_eca2ef-1e > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2072_eca2ef-1e > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:540px;margin-left:auto;margin-right:auto;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2072_eca2ef-1e > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2072_eca2ef-1e > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2072_eca2ef-1e > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2072_eca2ef-1e alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column2072_7b241e-ef > .kt-inside-inner-col,.kadence-column2072_7b241e-ef > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_7b241e-ef > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_7b241e-ef > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_7b241e-ef > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_7b241e-ef > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_7b241e-ef{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_7b241e-ef > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_7b241e-ef > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_7b241e-ef\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b, .wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b[data-kb-block=\"kb-adv-heading2072_9fd77b-6b\"]{margin-top:0px;text-align:center;line-height:1.2em;font-style:normal;text-transform:uppercase;}.wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_9fd77b-6b[data-kb-block=\"kb-adv-heading2072_9fd77b-6b\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<h1 class=\"kt-adv-heading2072_9fd77b-6b wp-block-kadence-advancedheading has-theme-palette-9-color has-text-color\" data-kb-block=\"kb-adv-heading2072_9fd77b-6b\">Provider <br>Forms and Documents<\/h1>\n<\/div><\/div>\n\n<\/div><\/div><\/div><\/div>\n\n<\/div><\/div>\n\n<style>.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1440px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var(--global-kb-spacing-lg, 3rem);padding-bottom:var(--global-kb-spacing-xl, 4rem);grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id2072_3fa05d-30 > .kt-row-layout-overlay{opacity:0.30;}.kb-row-layout-id2072_3fa05d-30 ,.kb-row-layout-id2072_3fa05d-30 h1,.kb-row-layout-id2072_3fa05d-30 h2,.kb-row-layout-id2072_3fa05d-30 h3,.kb-row-layout-id2072_3fa05d-30 h4,.kb-row-layout-id2072_3fa05d-30 h5,.kb-row-layout-id2072_3fa05d-30 h6{color:var(--global-palette9, #ffffff);}@media all and (max-width: 1024px){.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id2072_3fa05d-30 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><section class=\"kb-row-layout-wrap kb-row-layout-id2072_3fa05d-30 alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column2072_161eaf-22 > .kt-inside-inner-col,.kadence-column2072_161eaf-22 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_161eaf-22 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_161eaf-22 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_161eaf-22 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_161eaf-22 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_161eaf-22{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_161eaf-22 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_161eaf-22 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_161eaf-22\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2, .wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2[data-kb-block=\"kb-adv-heading2072_e0096e-b2\"]{text-align:center;font-weight:400;font-style:normal;font-family:var( --global-body-font-family, inherit );}.wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_e0096e-b2[data-kb-block=\"kb-adv-heading2072_e0096e-b2\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<p class=\"kt-adv-heading2072_e0096e-b2 wp-block-kadence-advancedheading has-theme-palette-3-color has-text-color\" data-kb-block=\"kb-adv-heading2072_e0096e-b2\">Alliant Health Plans values its providers. Please find below helpful resources for all providers servicing AHP\u2019s members.<br>For your convenience, we have made the forms below fillable. To enable your computer to edit the forms, follow these&nbsp;<a href=\"https:\/\/alliantplans.com\/article\/instructions-for-fillable-pdf\/\" data-type=\"article\" data-id=\"4015\">instructions<\/a>.<\/p>\n\n\n<style>.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1440px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var(--global-kb-spacing-sm, 1.5rem);padding-bottom:var(--global-kb-spacing-sm, 1.5rem);grid-template-columns:repeat(2, minmax(0, 1fr));}.kb-row-layout-id2072_254d39-70 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap{grid-template-columns:repeat(2, minmax(0, 1fr));}}@media all and (max-width: 767px){.kb-row-layout-id2072_254d39-70 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id2072_254d39-70 alignnone wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-2-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column2072_3c6161-8a > .kt-inside-inner-col,.kadence-column2072_3c6161-8a > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_3c6161-8a > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_3c6161-8a > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_3c6161-8a > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_3c6161-8a > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_3c6161-8a{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_3c6161-8a > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_3c6161-8a > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_3c6161-8a\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f, .wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f[data-kb-block=\"kb-adv-heading2072_b187d4-7f\"]{padding-top:0px;padding-bottom:var(--global-kb-spacing-xxs, 0.5rem);line-height:1.8;font-style:normal;}.wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_b187d4-7f[data-kb-block=\"kb-adv-heading2072_b187d4-7f\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<h2 class=\"kt-adv-heading2072_b187d4-7f wp-block-kadence-advancedheading has-theme-palette-1-color has-text-color\" data-kb-block=\"kb-adv-heading2072_b187d4-7f\">General Resources<\/h2>\n\n\n<style>.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf:not(.this-stops-third-party-issues){margin-top:0px;margin-bottom:0px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list:not(.this-prevents-issues):not(.this-stops-third-party-issues):not(.tijsloc){margin-top:0px;margin-right:0px;margin-bottom:var(--global-kb-spacing-sm, 1.5rem);margin-left:0px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list{grid-row-gap:5px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf .kb-svg-icon-wrap{font-size:18px;color:#fd7c7c;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap .kt-svg-icon-list-single{margin-right:10px;}.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap, .kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .kt-svg-icon-list-item-wrap a{font-size:18px;}.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .kt-svg-icon-list-level-0 .kt-svg-icon-list-single svg{font-size:20px;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf .wp-block-kadence-listitem a{text-decoration:none;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf .wp-block-kadence-listitem a:hover{text-decoration:underline;}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .wp-block-kadence-listitem a{color:var(--global-palette3, #1A202C);}.wp-block-kadence-iconlist.kt-svg-icon-list-items2072_85a5d0-bf ul.kt-svg-icon-list .wp-block-kadence-listitem a:hover{color:var(--global-palette2, #2B6CB0);}<\/style>\n<div class=\"wp-block-kadence-iconlist kt-svg-icon-list-items kt-svg-icon-list-items2072_85a5d0-bf kt-svg-icon-list-columns-1 alignnone kt-list-icon-aligntop\"><ul class=\"kt-svg-icon-list\"><style>.kt-svg-icon-list-item-2072_898991-63 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_898991-63\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/provider-appeal-form\/\" data-type=\"document\" data-id=\"3784\">Provider Appeal Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_be8998-8e .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_be8998-8e\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/member-accident-injury-form\/\" data-type=\"document\" data-id=\"2912\">Member Accident Injury Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_cab7ff-6e .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_cab7ff-6e\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/commercial-transplant-facilities-adult\/\">Commercial Transplant Facilities (Adult)<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_d56df0-91 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_d56df0-91\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/commercial-transplant-facilities-pediatric\/\">Commercial Transplant Facilities (Pediatric)<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_08c6ab-bf .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_08c6ab-bf\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/provider-update-form\/\" data-type=\"document\" data-id=\"3821\">Provider Update Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_08c8ef-3a .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_08c8ef-3a\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/alliant-network-provider-search-instructions\/\" data-type=\"document\" data-id=\"3031\">Alliant Network Provider Search Instructions<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_9c11f2-12 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_9c11f2-12\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 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mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_9082b0-c9\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/authorization-for-the-release-of-protected-health-information-phi\/\" data-type=\"document\" data-id=\"3838\">Authorization for the Release of Protected Health Information (PHI)<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_b45b0c-54 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_b45b0c-54\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/alliant-health-plans-quick-reference-guide\/\" data-type=\"document\" data-id=\"3843\">Alliant Health Plans Quick Reference Guide<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_7a93dc-d7 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_7a93dc-d7\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/out-of-network-claim-payment-dispute-form\/\" data-type=\"document\" data-id=\"3848\">Out of Network Claim Payment Dispute Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_640727-82 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_640727-82\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a data-type=\"document\" data-id=\"3852\" href=\"https:\/\/alliantplans.com\/document\/provider-request-for-out-of-network-mac-payment\/\">Provider Request for Out of Network MAC Payment<\/a><\/span><\/li>\n<\/ul><\/div>\n\n\n\n<p><\/p>\n<\/div><\/div>\n\n\n<style>.kadence-column2072_1eab34-03 > .kt-inside-inner-col,.kadence-column2072_1eab34-03 > 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kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_0758ee-f2\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/prior-authorization-request-form\/\" data-type=\"document\" data-id=\"3860\">Prior Authorization Request Form<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_5b9ef9-63 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_5b9ef9-63\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/primary-care-physician-resource-depression\/\" data-type=\"document\" data-id=\"3864\">Primary Care Physician Resource: Depression Informational Presentation and Survey<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_1d3071-fd .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_1d3071-fd\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a href=\"https:\/\/alliantplans.com\/document\/procedures-requiring-prior-authorization-2\/\" data-type=\"document\" data-id=\"3872\">Procedures Requiring Prior Authorization<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_9aefa4-02 .kt-svg-icon-list-text 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85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\"><a data-type=\"document\" data-id=\"3878\" href=\"https:\/\/alliantplans.com\/document\/mohs-certifications-statement\/\">Mohs Certifications Statement<\/a><\/span><\/li>\n\n\n<style>.kt-svg-icon-list-item-2072_6dc9d8-00 .kt-svg-icon-list-text mark.kt-highlight{background-color:unset;font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}<\/style>\n<li class=\"wp-block-kadence-listitem kt-svg-icon-list-item-wrap kt-svg-icon-list-item-2072_6dc9d8-00\"><a href=\"https:\/\/alliantplans.com\/providers\/pharmacy-resources\/\" class=\"kt-svg-icon-link\"><span class=\"kb-svg-icon-wrap kb-svg-icon-fas_file-pdf kt-svg-icon-list-single\"><svg viewBox=\"0 0 384 512\"  fill=\"currentColor\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"  aria-hidden=\"true\"><path d=\"M181.9 256.1c-5-16-4.9-46.9-2-46.9 8.4 0 7.6 36.9 2 46.9zm-1.7 47.2c-7.7 20.2-17.3 43.3-28.4 62.7 18.3-7 39-17.2 62.9-21.9-12.7-9.6-24.9-23.4-34.5-40.8zM86.1 428.1c0 .8 13.2-5.4 34.9-40.2-6.7 6.3-29.1 24.5-34.9 40.2zM248 160h136v328c0 13.3-10.7 24-24 24H24c-13.3 0-24-10.7-24-24V24C0 10.7 10.7 0 24 0h200v136c0 13.2 10.8 24 24 24zm-8 171.8c-20-12.2-33.3-29-42.7-53.8 4.5-18.5 11.6-46.6 6.2-64.2-4.7-29.4-42.4-26.5-47.8-6.8-5 18.3-.4 44.1 8.1 77-11.6 27.6-28.7 64.6-40.8 85.8-.1 0-.1.1-.2.1-27.1 13.9-73.6 44.5-54.5 68 5.6 6.9 16 10 21.5 10 17.9 0 35.7-18 61.1-61.8 25.8-8.5 54.1-19.1 79-23.2 21.7 11.8 47.1 19.5 64 19.5 29.2 0 31.2-32 19.7-43.4-13.9-13.6-54.3-9.7-73.6-7.2zM377 105L279 7c-4.5-4.5-10.6-7-17-7h-6v128h128v-6.1c0-6.3-2.5-12.4-7-16.9zm-74.1 255.3c4.1-2.7-2.5-11.9-42.8-9 37.1 15.8 42.8 9 42.8 9z\"\/><\/svg><\/span><span class=\"kt-svg-icon-list-text\">Pharmacy Resources <\/span><\/a><\/li>\n<\/ul><\/div>\n<\/div><\/div>\n\n<\/div><\/div><\/div><\/div>\n\n\n<style>.kadence-column2072_95695f-05 > .kt-inside-inner-col,.kadence-column2072_95695f-05 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column2072_95695f-05 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column2072_95695f-05 > .kt-inside-inner-col{flex-direction:column;}.kadence-column2072_95695f-05 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column2072_95695f-05 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column2072_95695f-05{position:relative;}@media all and (max-width: 1024px){.kadence-column2072_95695f-05 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column2072_95695f-05 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column2072_95695f-05\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9, .wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"]{text-align:center;font-style:normal;}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] a, .kt-adv-heading-link2072_53e924-a9, .kt-adv-heading-link2072_53e924-a9 .kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"]{color:var(--global-palette3, #1A202C);}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] a:hover, .kt-adv-heading-link2072_53e924-a9:hover, .kt-adv-heading-link2072_53e924-a9:hover .kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"]{color:var(--global-palette2, #2B6CB0);}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] a, a.kb-advanced-heading-link.kt-adv-heading-link2072_53e924-a9{text-decoration:none;}.wp-block-kadence-advancedheading.kt-adv-heading2072_53e924-a9[data-kb-block=\"kb-adv-heading2072_53e924-a9\"] a:hover, a.kb-advanced-heading-link.kt-adv-heading-link2072_53e924-a9:hover{text-decoration:underline;}<\/style>\n<p class=\"kt-adv-heading2072_53e924-a9 wp-block-kadence-advancedheading has-theme-palette-3-color has-text-color hls-hover_underline\" data-kb-block=\"kb-adv-heading2072_53e924-a9\">For additional information, please contact Provider Relations at<mark class=\"kt-highlight\"><a href=\"tel:8006648480\"> 800-664-8480<\/a><\/mark> or&nbsp;<a>ProviderRelations@alliantplans.com<\/a>.<\/p>\n<\/div><\/div>\n\n<\/div><\/section>","protected":false},"excerpt":{"rendered":"<p>Provider Forms and Documents Alliant Health Plans values its providers. Please find below helpful resources for all providers servicing AHP\u2019s members.For your convenience, we have made the forms below fillable. To enable your computer to edit the forms, follow these&nbsp;instructions. General Resources Medical Resources For additional information, please contact Provider Relations at 800-664-8480 or&nbsp;ProviderRelations@alliantplans.com.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":42,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_kadence_starter_templates_imported_post":false,"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"_kad_post_classname":"","_jet_sm_ready_style":"","_jet_sm_style":"","_jet_sm_controls_values":"","_jet_sm_fonts_collection":"","_jet_sm_fonts_links":"","footnotes":""},"class_list":["post-2072","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.6 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Provider Forms and Documents - Alliant Health Plans<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alliantplans.com\/providers\/provider-forms-and-documents\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Provider Forms and Documents\" \/>\n<meta property=\"og:description\" content=\"Provider Forms and Documents Alliant Health Plans values its providers. 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