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:
Use this form to submit a request for a referral or authorization.
Appeal Request Form
Use this form to submit a request to appeal a claim.
DME Request Fax 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 Update Form
Existing Piedmont network providers, please use this form to submit updates to your information.
ERS User Request Form
Please complete this form to request access to our Electronic Referral System (ERS).
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.