Independence Provider Hub  

Forms for providers

Our most commonly used forms are available below:

Additional resources

The peer-to-peer process streamlines workflows, improves cost-efficiencies, and complies with accreditation requirements. To participate in the peer-to-peer process, please complete the Peer-to-peer Request Form.

If you are interested in having a registered nurse Health Coach work with your Independence patients, please complete a Physician Referral Form or contact us by calling 1-800-313-8628.

Providers must complete a request form for all prescription drugs that require prior authorization. More information about this process is available on the prior authorization page.

Use this form to request a copy of your provider contract or a provider rate/fee schedule for a specific specialty.

Forms are not used to verify member eligibility or to check the status of a claim. Instead, please use PEAR Practice Management on the Provider Engagement, Analytics & Reporting (PEAR) portal or call 1-800-ASK-BLUE (1-800-275-2583) to access the Provider Automated System.