As a valued Piedmont Provider, our goal is to assist you in serving our members.  To that end, participating providers can download printable Provider Forms by clicking on the following links: 

• Referral/Authorization Request
  Use this form to submit a request for a referral or authorization.

• Corrected Claim Request Form
  Use this form to submit a correction on a rejected claim.

• Appeal Request Form
  Use this form to submit a request to appeal a claim.

• DME Authorization Request Form
  Use this form to easily request authorization for DME.

• Network Participation Request Form (Organization)
  Please complete this form for your organization or practice to request to join Piedmont's provider network.

• Network Participation Request Form (Individual)
  Please complete this form for an individual provider to request to join Piedmont's provider network.  

• Network Participation Request Form (Individual Nurse Practioner)
  Please complete this form for a Nurse Practioner provider to request to join Piedmont's provider network. 

• Network Participation Update Form
  Existing Piedmont network providers, please use this form to submit updates to your information.

• Provider Manual  
  A provider's guide to resources, processes and information about working with Piedmont Community Health Plan.

• CPAP Authorization Request Guide 
  A one page infographic to summarize requirements for CPAP authorization requests.

• Security Standards
  Security standards as referenced from our portal “Information Access and Security Agreement."