The forms below are in PDF format. You must have Acrobat Reader to view these files.  Please print the file, fill out the form, and mail/fax it back to us.

• Detailed Explanation of Non-Coverage
• Detailed Notice of Discharge
• Notice of Discharge and Medical Appeal Rights
• Notice of Medicare Non Coverage
• General Advance Determination Fax Form
• HIT Advance Determination Fax Form
• Inpatient Advance Determination Fax Form
• Outpatient Therapy Advance Determination Fax Form
• Part B Drug Advance Determination Fax Form
• SNF Inpatient Rehab Advance Determination Fax Form
• Cardiac Inpatient Advance Determination Fax Form
• DME Advance Determination Fax Form