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Click ‘Get Form’ to open the ash modification form in the editor.
Begin by entering the patient’s name, ID number, and health plan details in the designated fields. Ensure accuracy for seamless processing.
Select whether you are submitting a Reopen or Modification request. For Reopen, provide a clear rationale for additional information or corrections needed.
If choosing Modification, specify any changes to treatment dates and include the start and end dates in the required format (mm/dd/yyyy).
Detail any additional office visits requested, along with clinical rationale. Remember that modifications for extra visits cannot be submitted with date extensions.
Complete the signature section by having the treating acupuncture practitioner sign and date the form before submission.
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American Specialty Health (ASH) provides chiropractic and acupuncture coverage for all SISC plans. Anthem PPO Members may access ASH coverage at the cost allowed by their selected plan.
What is the Ash Connect app?
If your favorite workout location isnt a participating fitness center, you can still take part in the rewards program through the ASHConnect app. You can quickly and easily locate fitness centers and track your physical activity at more than 43,000+ fitness centers nationwide to earn rewards.
Is American Specialty Health a real company?
We have been recognized repeatedly for the quality, reliability, and safety of our programs and services by national organizations such as NCQA and URAC. And, as an employer, weve received many awards for walking the talk of healthy living.
What is the Ash network?
This additional information should also be faxed to 877.795. 2746 when submitting your claim electronically through ASHLink or ASH Clearinghouse.
How do I submit a claim to American Specialty Health?
American Specialty Health Incorporated (ASH), through its subsidiaries, contracts with a vast network of thousands of specialty health care practitioners to offer effective and efficient services to health plan members nationwide.
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ASH MNR formASH MNR form physical therapy PDFASH authorization form for physical therapyCigna ASH physical therapy authorization formASH provider status change request formASH medical necessity Review formCigna ASH medical necessity review form physical therapyASH auth FORM
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