Provider Manual & Forms

2020 Allwell Provider and Billing Manual (PDF)

Provider Forms

• Inpatient Authorization Form (PDF)
• Outpatient Authorization Form (PDF)
• Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
  
• Inpatient Neuropsychological Testing Authorization Request Form (PDF)
• Outpatient Psychological Testing Authorization Request Form (PDF)
• Outpatient Treatment Request Form (PDF)
• Non-Par Provider Appeal Form (PDF)
• Par Provider Payment Reconsideration Form (PDF)

Other Resources

• QMB Balance Billing FAQs - information about balance billing qualified medicare beneficiaries
• Sunflower Member ID Card Reference Sheet (PDF)

Training Resources

Training & Education

Orientation References

• Allwell Booklet Provider Guide (PDF)
• Allwell Payspan (Electronic Funds Transfer) (PDF)
• Allwell Prior Authorization Guide (PDF)
• Allwell Secure Provider Portal (PDF)
• Allwell Quick Reference Guide (PDF)