For your convenience, we've categorized our most frequently used forms. If you can't find the form you need or require further assistance, please contact us.
Corrected claim cover sheet Use this form to correct billing information on a previously processed claim.
Other coverage questionnaire enrollment Use this form to provide information about other healthcare coverage a patient may have.
Overpayment notification form Use this form to notify LifeWise of an overpayment your office received.
Support document cover sheet Use this form to submit supporting documentation that is required to process a claim.
Appeals form Sample form template for the exchange of information between medical and behavioral health providers.
Out-of-network exception request
Admission notification
Prior authorization request
Durable medical equipment Use this form to verify if DME is medically necessary.
Confidential exchange of information form Sample form template for the exchange of information between medical and behavioral health providers.