Option 1

New Orders

Please FAX new orders to:
(866) 453-3332

ORDER FORM

Patient information needed:

  • Doctor’s Order
  • History and Physical
  • Height and Weight
  • Face Sheet
  • Insurance Information

PLEASE CALL (866) 883-1188 TO CONFIRM.

Thank you!

Insurance Partners

National/ Regional (Applies to all sites)
CIGNA through CareCentrix (3/10)
CorVel Corporation
Great West through CareCentrix
Health Mgmt Associates (HMA IMx)
Medicare- All Regions
Private Health Care Systems PPO (PHCS) IM/X HMA
TriWest/TriCare Regional CA serviced from AZ
United HealthCare
USA MCO
Humana Gold Choice


Arizona
Aetna PPO
Affinity Hospice
AHCCCS
Beech Street
Blue Cross Blue Shield Arizona
Capstone
Care 1st Health Plan of Arizona
Children’s Rehabilitative Services (CRS)
Comprehensive Medical and Dental Program (CMDP)
Desert Canyon Community Care
Desert Oasis Hospice
Evercare
HealthNet of AZ
Hospice Family Care
Humana  Choice PPO (commercial only)
Premera Blue Cross (AZ, WA, AK, OR)
Mercy Care Plan
Maricopa Health Plan
PacifiCare Arizona (Secure Horizons)
PacifiCare Arizona (commercial)
Phoenix Health Plan
Pinal/Gila LTC
Premier Hospice
SCAN Health Plan of Arizona, Inc.
University Family Care University Physicians Health Plan (UPHP)
Vista Care USA
*Bridgeway
*Indian Health Services (IHS)

California
Alameda Alliancefor Health
Beech Street
Central Coast Alliance
Health Plan of San Mateo
Partnership Health plan of CA
Santa Clara Family Health
*Blue Shield of California
*Brown & Toland Physicians
*Chinese Community Health Plan CCHP
*San Francisco Health plan

Colorado
Aetna
Anthem BCBS
Beech Street
Centura Health at Home
Child Health Plan Plus (CHP+)
Colorado Access (CHP+)
CO Medicaid
Denver Health Medical Plan
Humana Choice Care (commercial only)
NE Medicaid
New West Physicians
Medical Network (Co. Spgs. Only)
MT Medicaid
Physician Health Partners (DYC, CDOC)
Rocky Mtn. Health Plan
WY Medicaid

Nevada
AMERIGROUP
Anthem BCBS (Medicaid HMO PPO)
Health Care Partners of Nevada/Humana(PacifiCare Secure Horizons)
Nevada Medicaid
Teachers Health and Trust
*Coventry

Oregon
Care Oregon
Doctors of Oregon Coast Southwest (DOCS)
LIPA (Lane Individual Practice Association)
Family Care
ODS Network
ODS PPO Advantage (Medicare)
ODS Community Health Plan (OHP) Medicaid
Oregon Medicaid
Oregon Medicare
Premera Blue Cross (AZ, WA, AK, OR)
Providence Home Services
Regence BlueCross BlueShield of Oregon
Samaritan Health Plan
Trillium Community Health Plan
Tuality Health Plan
*Douglas County IPA (DCIPA,LLLC)
*MIVIPA-(Mid Valley IPA)

Washington/ Northwest
Community Health Plan of WA
First Choice Health Network
Great-West
Idaho Medicaid
Molina Health Care of Washington
Premera Blue Cross (AZ, WA, AK, OR)
Regence of Washington
Uniform Medical Plan
WA Medicaid
*Indian Health Services (IHS)