Manuals, Forms and Resources
Provider Manual
The Provider Manual has everything you need to know about member benefits, coverage, and provider guidelines. Click the link below to view or save a copy.
Documents and Forms
- Meridian Medicaid Authorization Lookup
- PA Codes - Dental Services (PDF)
- Administrative Day Request Form (PDF)
- Authorization Referral Form
- Acknowledgment of Hysterectomy Form (PDF)
- Bariatric Preoperative Evaluation Checklist (PDF)
- Consent to Sterilization Form (PDF)
- Data Exchange Request Form (PDF)
- Electronic Medical Request Form (PDF)
- Primary Care Provider Reassignment Form (PDF)
- IL Medicaid Provider Referral Grid (PDF)
- Post-Service Medical Necessity Appeals (PDF)
- Comprehensive Community Support Services - FAQs (PDF)
Please consult the provider manual (PDF). Additional billing information can be found in the Illinois Association of Medicaid Health Plans (IAMHP) Comprehensive Billing Manual.
EPSDT forms can be found within the EPSDT toolkit.
- Meridian's Advance Health Directives Information (PDF)
- Directivas Anticipadas información de Meridian (PDF)
- Advance Directives (illinois.gov) (PDF)
- Living Will Declaration Form (illinois.gov) (PDF)
- Living Will Declaration Form (En Español) (illinois.gov) (PDF)
- Power of Attorney for Health Care (illinois.gov) (PDF)
- Illinois Client Enrollment Services
- Illinois Dept of Healthcare and Family Services
- Instructions Illinois Medical Assistance Program Privider Enrollment Application (PDF)
- Provider Enrollment Application Illinois Medical Assistance Program (PDF)
- Instructions for Completion of Illinois Medical Assistance Provider Enrollment (DPA Form 2243) (PDF)
- Illinois Department of Human Services Community Reintegration Program
- Antipsychotic and Antidepressant Medication Adherence (PDF)
- Applied Behavioral Analysis (ABA) Outpatient Treatment Request Form (PDF)
- Applied Behavioral Analysis Outpatient Treatment Request Checklist (PDF)
- Incomplete Provider Information (PDF)
- Behavioral Health Discharge Transition of Care Form (PDF)
- Behavioral Health Follow-Up Measures (PDF)
- Behavioral Health Measure Changes (PDF)
- METS Provider Flyer (PDF)
- METS FAQ Sheet (PDF)
- Substance Use Disorder Treatment and Engagement (PDF)
- The Importance of Depression Screenings (PDF)
- The Importance of Regular Follow-Up for ADHD (PDF)
The Partnerships in Care (PiC) program
The PiC program employs a data-driven approach to strengthen provider collaborations and optimize patient outcomes of providers whose utilization patterns are 2-3 standard deviations above the norm compared to peers with similar demographics and specialties. By analyzing member clinical data, PiC identifies opportunities for improvement and facilitates targeted interventions to enhance behavioral health service delivery.