• Helpful Resources and Forms

    Utilize these quick links to take you to forms you may need including authorization forms, medical reimbursement forms, electronic transfer forms, and more.

    Prior Authorization Form

    Last Updated: 10/14/2019

    Download

    Admission Form

    Last Updated: 10/14/2019

    Download

    Electronic Funds Transfer (EFT) Authorization Form

    Last Updated: 2/04/2020

    Download

    Utilization Management Program

    Last Updated: 10/14/2019

    Download

    Quality Improvement Program

    Last Updated: 10/14/2019

    Download

    CSH Provider Manual

    Last Updated: 01/16/2020

    Download

    Provider Quick Reference Guide

    Last Updated: 10/31/2019

    Download

    Provider Portal (Claims and Eligibility)

    Last Updated: 11/18/2019

    Download

    PHI Form

    Last Updated: 11/18/2019

    Download

    Member Reimbursement Medical Form

    Last Updated: 11/18/2019

    Download

    Member Reimbursement Medical Form – Medications

    Last Updated: 11/21/2019

    Download

    Customer Service

    If you have questions about your plan, services, and care, call customer service at
    1-877-364-4566 TTY: 711

    Last Updated on October 12, 2020, 11:39 pm CDT

    Y1045_MK_W003-092520

    Clear Spring Health, PO Box 278530 Miramar, FL 33027 ©Copyright 2020 Clear Spring Health. All rights reserved.


    Clear Spring Health has a contract with Medicare to offer PPO, HMO, and PDP Plans. Eon Health has a contract with the Georgia Medicaid program and a contract with the South Carolina Medicaid program. Enrollment in these plans depends on contract renewal.

    To learn more, please call (877) 364-4566 TTY users should call 711. Our office hours are October 1 – March 31, seven days a week, 8:00 a.m. – 8:00 p.m. and from April 1 – September 30, Monday through Friday, 8:00 a.m. – 8:00 p.m. (you may leave a voicemail Saturday, Sunday and Federal Holidays).

    Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1-877-364-4566 (TTY: 711)