Document Library

• DME authorization form - SSM employee health plan

  pdf

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• General authorization form - SSM employee health plan

  pdf

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• SNF authorization form - SSM employee health plan

  pdf

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• EDI Setup Form 39113

  pdf

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• General prior authorization form

  pdf

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• Behavioral health authorization form - SSM employee health plan

  pdf

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• Transplant program prior authorization request form

  pdf

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• Out-of-network provider prior authorization request form

  pdf

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• Inpatient notification requirements form

  pdf

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• Behavioral health (BH)/substance use disorder (SUD) prior authorization request form

  pdf

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