Providers

Materials for Providers

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Specialist Referrals Codes Requiring Prior Authorization

Referrals to specialty providers must be completed by the client’s PCP
All visits to specialists must have a current prior authorization

Moffitt Dx Codes

HCHCP MOFFITT DX Codes

Moffitt Announcement and Referral Processing

Healthy Living Referral Process

Healthy Living Referral Process Provider Instructions

FAX forms

General HCHCP Fax Form

Reconsideration HCHCP Fax Form

HELP

KEPRO's training materials are available in various file formats, requiring specific tools to enable you to view them. The file types and links to the associated tools which you may need to download and install are listed below:

For file type .pdf use the Adobe Acrobat Reader.
For file types .ppt and .pptx use the Microsoft PowerPoint viewer if you do not have Microsoft PowerPoint.
For file type .avi use this codec: http://www.compression.ru/video/ls-codec/msu-sc-codec.exe

Chiropractic Provider Instruction

Provider Instructions for Chiropractic Referral

Provider Checklists

Want to avoid hold-ups caused by missing information in service requests?

Check out our Provider Checklists. These handy reference lists will help you determine at a glance all the information required for each service type. Don't be stuck retrieving information twice!

Use the checklists for once-and-done submission!

Dental

Currently, there are no materials available for this category. Please check back later.

DME

DME – Power Wheelchairs

BiPAP Questionnaire

CPAP Questionnaire

Insulin Pump

Inpatient Services

Currently, there are no materials available for this category. Please check back later.

Outpatient Services

Blepharoplasty

Breast Reconstruction

Breast Reduction Mammoplasty

Outpatient Rehab- Occupational Therapy (OT) Initial

Outpatient Rehab- Physical Therapy (PT) Initial

Outpatient Rehab- Speech Therapy (ST) Initial

Outpatient Rehab-Cardiac Post Eval

Outpatient Rehab-Pulmonary Post Eval

Urology Checklist for Cystoscopy-Cystourethroscopy

Urology Checklist for Prostratic RF Thermotx

Varicose Veins

Wound Care-Hyperbaric Oxygen Therapy (HO2)

MRI & CT Cervical Spine Questionnaire

MRI & CT Lumber Spine Questionnaire

Outpatient Imaging

Computed Tomography (CT) Abdomen

Computed Tomography (CT) Abdomen and Pelvis

Computed Tomography (CT) Brain

Computed Tomography (CT) Cervical Spine

Computed Tomography (CT) Chest-Cardiac

Computed Tomography (CT) Colon

Computed Tomography (CT) Extremity

Computed Tomography (CT) Kidney

Computed Tomography (CT) Lumbar Spine

Computed Tomography (CT) Neck

Computed Tomography (CT) Orbit

Computed Tomography (CT) Sinuses

Computed Tomography Angiogram (CTA) Coronaries

Magnetic Resonance Angiogram (MRA) Brain

Magnetic Resonance Cholangiopancreatography (MRCP)

Magnetic Resonance Imaging (MRI) Abdomen

Magnetic Resonance Imaging (MRI) Ankle

Magnetic Resonance Imaging (MRI) Brain

Magnetic Resonance Imaging (MRI) Breast

Magnetic Resonance Imaging (MRI) Cervical Spine

Magnetic Resonance Imaging (MRI) Elbow

Magnetic Resonance Imaging (MRI) Foot

Magnetic Resonance Imaging (MRI) Hip

Magnetic Resonance Imaging (MRI) Knee

Magnetic Resonance Imaging (MRI) Lumbar Spine

Magnetic Resonance Imaging (MRI) Neck

Magnetic Resonance Imaging (MRI) Orbit

Magnetic Resonance Imaging (MRI) Pelvis

Magnetic Resonance Imaging (MRI) Pituitary

Magnetic Resonance Imaging (MRI) Shoulder

Magnetic Resonance Imaging (MRI) Thoracic Spine

Magnetic Resonance Imaging (MRI) Wrist

Nuclear Stress Test-Thallium-Technetium-Sestamibi

Positron Emission Tomography (PET) Whole Body

Ultrasound (US) Abdomen

Ultrasound (US) Pelvis

Ultrasound (US) Scrotum

Ultrasound (US) Transrectal

Pain Management

Acute Pain of Cervical Spine

Acute Pain of Lumbar Spine

Hip Pain & Sacro-Iliac Joint Pain

Shoulder Pain

Speciality Physician Visit for Pain Management

Help

Kepro's training materials are available in various file formats which may require specific tools to enable you to view them. The file types and links to the associated tools which you may need to download and install are listed below:

For file type .pdf use the Adobe Acrobat Reader.
For file types .ppt and .pptx use the Microsoft PowerPoint viewer if you do not have Microsoft PowerPoint.
For file type .avi use this codec: http://www.compression.ru/video/ls-codec/msu-sc-codec.exe

Provider Reference