FORMS & INFORMATION

• California Participating Physicians Application

• Key - Acknowledgement of Financial Responsibility Form

• Commercial Plans (Blue Shield, Health Net, United Health Care, Anthem Blue Cross) Provider Dispute Resolution Request Form - Send to Key Medical Group

• Medicare Advantage - 1st level of appeal - Redetermination - Send to Key Medical Group

• Medicare Advantage - 2nd level of appeal - Reconsideration - Send to Health Plan

The documents above are in Adobe Reader format. You can obtain Adobe Reader for free by going to the Adobe web site.