MEMBERS
PROVIDERS
PROVIDER DIRECTORY
CONTACT US
COVID-19
Member Forms
Authorization to Release Information
Medical Claim Form
Dental Claim Form
Provider Forms
Prior Authorization Request Form
EFT & ERA Set-Up
Physician Claim Form HCFA 1500
NEED HELP?
(844) 378-7103
Privacy Policy
Member Rights & Responsibilities
HIPAA
© Deaconess OneCare Health Plan
JSON MRFiles
Hercules Health
Please login to the web portal for additional information regarding benefit limits