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Materials and Resources

To send requested documents to Provider Services via fax, please fax back to 1­-312­-724-9256 or send back via email to [email protected]

The following resources can help you with our processes and procedures:

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2017 NextLevel Health Provider Manual

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2016 HFS Managed Care Manual for Medicaid Providers

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Provider Services Quick Resource Guide

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Claims “Cheat Sheet”

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EFT Request Form

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Request for Prior Authorization Form

NextLevel Health Provider Inquiry Form

NextLevel Health CI Intake Form

NextLevel Health Drug Formulary

IRS W-9 Form

Educational Information and Links:

Americans with Disabilities Act
You are required to comply with the Americans with Disabilities Act (ADA), which ensures medical services are accessible for all individuals (Click Here).