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Documents & Forms

If you can’t find what you’re looking for below, our Customer Care team can help.

HRSN MTM Assessment Referral Form

This form can be used by PCPs and Registered Dieticians to complete the required assessment for members seeking HRSN Medically Tailored Meals (MTM).

HRSN MTM Benefit Overview

This guide provides an overview of the HRSN Medically Tailored Meals benefit for clinics and providers who may have patients with eligible conditions.

Potential Quality of Care Concern Referral & Investigation Form

Use this form to report potential quality-of-care concerns for UHA members. UHA reviews and investigates referrals to support safe, high-quality care across our contracted provider network.

Quality Pool Distribution Plan

UHA’s distribution plan for its Quality Pool and Challenge Pool earnings. The purpose of the plan is to inform UHA’s Participating Providers, including Social Determinants of Health and Equity (SDOH-E) and public health partners, about UHA strategies and processes for distribution of Quality Pool funds.

Consensus WCHA 2025–26 Respiratory Virus Season Immunization Recommendations

Professionally Administered Drug (PAD) Grid

Healthy Start Ages 9 -12 Postcard

Payspan/Zelis Customer Service FAQs

Provider Reconsideration and Claim Dispute Form