Key Medical Group Provider 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.