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Marketplace Premium Payment 1-888-518-7597
Individual & Group Coverage: (800) 400-PCHP
Medicare Advantage: (877) 210-1719
TTY: 711

Provider Forms

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

  • ERS User Request Form                                                                                                                                                                                                                 Please complete this form to request access to our Electronic Referral System (ERS).