Priority Partners Referral Information & Forms

• Self Referral Handbook for Providers
• Outpatient Benefit Guidelines
• Automated Voice Response Unit Information
• Newborn Notification Requirement

Forms

• Maryland Uniform Credentialing Form
• Maryland Uniform Dental Credentialing Form
• Primary Care Provider Change Form
• Primary Care Provider Consent to Accept New Patient Form
• Maryland Uniform Consultation Referral Form
• Outreach Referral Form
• Special Needs Referral Form
• Same Day PreAuthorization
• Referral To Health Educator Form
• Newborn Enrollment Notification Form
• Maternity and Newborn Authorization
• Behavioral Health Referral Assessment Form
• SUBOXONE / SUBUTEX Prior Authorization Form
• Pharmacy Prior Authorization Form
• Synagis Prior Authorization Form
• Emergency Department Policy