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​Self-Help Forms

Please access all our available​ self-help forms below.

EpicLink

GHCEpicLink Partner Agreement
GHCEpicLink Site Coordinator Agreement
GHCEpicLink Handbook

Claims and Enrollment Setup

GHC-SCW EDI Form
834 Setup Form 
834 Companion Guide, Version 5010
EFT Authorization Form

Enrollment Method O​ptions​

Medical Management

Prior Authorization Request Form
Initial Notification of Outpatient Behavioral Health Services Form   
Request for Ongoing Authorization of External Behavioral Health Services Form
Transition of Care Form

Medical Management - Sauk County Only​

Initial Notification of Outpatient Behavioral Health Service Form
Request for Authorization of External Behavioral Health Service Form

Pharmacy

Medication Prior Authorization Form

Provider Information

GHC-SCW Provider Resource Manual
Reference Guide to Key Network Contact Information​

PLAN PROVIDERS
  • Epic Link
  • Member Safety
  • Prior Authorization Information
  • Services Requiring Prior Authorization
  • Forms To Submit Prior Authorization Requests
  • Provider Relations Contacts
  • Provider Resource Manual
  • Quality Management Plan
  • Self Help Forms
  • Understanding Member Coverage
GHCMYCHART LOG-IN
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  • CARE ONDEMAND
PLAN PROVIDERS
  • Epic Link
  • Member Safety
  • Prior Authorization Information
  • Services Requiring Prior Authorization
  • Forms To Submit Prior Authorization Requests
  • Provider Relations Contacts
  • Provider Resource Manual
  • Quality Management Plan
  • Self Help Forms
  • Understanding Member Coverage
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Group Health Cooperative of South Central Wisconsin (GHC-SCW) Admin Offices, 1265 John Q Hammons Dr., Madison, WI 53717-1962 All Rights Reserved MyChart licensed from Epic Systems Corporation Text - Copyright 1999-2015. Patents pending.
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