• Request access to your health plan records (PDF)
• Make changes to your health plan records for members (PDF)
• Restrict access to your health plan records for members (PDF)
• Request for confidential communications for Oregon members (PDF)
• Request for confidential communications for Washington members (PDF)
• Allow Providence Health Plans to share your protected health information with a third party for members (PDF)

Our Care Management team is ready and available to assist you with things like transitioning from one health plan to another, finding and establishing with a new physical or behavioral health provider, coordination between providers, and much more.

Go to our transition of care page to learn more about all the support our team can provide and how to get started."

Most providers bill Providence Health Plan directly; however, if you must submit a medical claim to Providence, please use these forms: 

• Medical claim form (PDF) 
• Mental health/chemical dependency claim form (PDF)
  For Providence St. Joseph Health Southern California caregivers ONLY: please use this form for mental health/chemical dependency reimbursement (all dates of service).
  
  For ALL OTHER members: Use this form for mental health/chemical dependency reimbursements for dates of service on or before 12/31/2020. For services on or after 1/1/2021, use Medical claim form (above).
• Alternative care claim form for providers (PDF)
• Medical travel reimbursement form (PDF)
• Transplant travel reimbursement form (PDF)

• Prescription drug reimbursement request form (PDF)
• Prescription drug prior authorization form (PDF)
• Uniform prior authorization prescription request form (PDF)