Forms Resource
Listen, inform and advise.

Forms Resource

Prior Authorization Form

This is a generic form used by Phoenix Benefits Management. Some plans and situations may require additional information in order to get a drug authorized.

Prescription Claim Reimbursement Form

For claim reimbursement, complete and mail this form to Phoenix Benefits Management.

Business Associate Agreement

Agreement between Customer and Business Associate when one creates or receives Protected Health Information for use in providing services or products to Customer.

Authorization for Disclosure of Personal Health Information

Your privacy is protected by federal and state law, thus, we need your permission to disclose any information to outside parties. Please complete every section in this form.

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