Forms
Claims
- Dental Claim Form
- Medical/Vision Claim Form
- Rx Drug Claim Form – Commercial (standard pharmacy benefit)
- Rx Drug Claim Form – Commercial Major Medical
- Rx Drug Claim Form – Washington State Rx Services (UMP)
- Prescription Compound Drug Claim Form
- Tobacco Cessation Claim Form
Individual Enrollment/Changes
Appeals and grievances
HIPAA/Privacy
- Authorize ODS to use/disclose information about a member - Instructions
- Authorize Provider or Hospital to use/disclose information to ODS - Instructions
Oral Health, Total Health
Other Forms
Log in to Benefit Tracker
Check benefits and eligibility
Log in to Benefit Tracker
Check benefits and eligibility
Shopping for health insurance?
Shopping for health insurance?
