Forms

For your convenience, many of our required forms are available here. These forms are for Georgia providers. If you need forms for North Carolina, South Carolina, or Tennessee, please go to Integrated-ActivHealthCare's website.

• Electronic Claims Enrollment Forms

• Treatment Plan Form

• Treatment Plan Form - Fillable

• Credentialing documents appropriate to Georgia

• Re-credentialing documents appropriate to Georgia

• Address change forms:

• W-9 Tax Form

• Provider Information Form

• Location Information Form