Provider Forms

• Forms
• Manual
• Publications

To make it easy for you to work with CCStpa, you'll find a variety of forms here.

• Admission Notification
• Chiropractic Prior Authorization Request
• Durable Medical Equipment and Medical Supply Prior Authorization
• Early Intensive Behavioral Intervention Autism Spectrum Disorder Service Request
• EPNI Provider Automatic Payment
• Guide for Completing the CMS-1450 (Institutional Claims) Form
• Guide for Completing the CMS-1500 (Professional Claims) Form
• Individual Practitioner Provider Addition and Termination
• Minnesota Uniform Form for Prescription Drug Prior Authorization (PA) Requests and Formulary Exceptions (PDF)
• Minnesota’s Universal Outpatient Mental Health/Chemical Health Authorization
• Prior Authorization: PT/OT/ST
• Prior Authorization Request
• Provider Appeal Non-Minnesota
• Provider Contracting
• Provider Demographic Change
• Provider Inquiry
• Provider TIN Change
• Quantity Limit Physician Fax Form
• Sample Waiver: General
• Step Therapy Authorization
• Transplant Pre-Service Request