US Family Health Plan Forms

US Family Health Plan provides immediate access to required forms and documents to assist our providers in expediting claims processing.

• Acknowledgement and Financial Responsibility Statement
• Authorization Request Form
• Maryland Uniform Credentialing
• Maryland Uniform Referral
• Medical Admission or Procedure Authorization Request (not for medical injectable requests)
• Pharmacy Compound Prior Authorization Request
• Pharmacy Prior Authorization Request
• Pharmacy Synagis Prior Authorization Request
• Provider Update 

If you have any trouble downloading the above files, View Download Instructions.

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