Health Tradition with Mayo Clinic Health System
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Provider Forms

Frequently Used Forms

Claim Form:

  • Claim Resubmission Form

Referral Forms:

  • Health Tradition Care Plus Plan: In-Network Referral Form
  • Health Tradition Care Plus Plan: Out-of-Network Referral Form
  • Health Tradition Only: External Referral Request Form

Services that Require Authorization:
Applies to all Health Tradition and Health Tradition Care Plus Plans

  • Health Tradition Services Requiring Preauthorization

Authorization Forms:
Applies to all Health Tradition and Health Tradition Care Plus Plans

  • Cologuard Prescription Form
  • Inpatient Pre-Certification/Notification Form
  • Medical Clearance Form for Health Tradition Low Back Pain Program
  • Medication Preauthorization Form
  • Medication Testing – Hydroxychloroquine
  • Medication Testing – Methotrexate
  • Medication Testing – Vectra DA
  • Pre-Authorization/Prior-Authorization Request Form
  • Pre-Authorization/Prior-Authorization – Behavioral Health Form
  • Preauthorization / Prior-Auth Oncology Request
  • Provider Update Form
  • Psychological/Neuropsychological Testing Authorization Form
  • 65Plus Skilled Nursing Facility Notification Form
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