ProviderConnect NX supported forms

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This table lists the myAvatar forms supported in ProviderConnect NX.

Area	Forms
Episode Management	Admission Admission (Outpatient) Discharge
User / Account Management	Financial Eligibility Fast Financial Eligibility Financial Investigation Change Current Password Client Other Healthcare Coverage (Cal-PM only) Real Time Inquiry (270) Request (Cal-PM only)
Client Information	Update Client Data Diagnosis Women’s Health History CSI Admission(Cal-PM only) CSI Assessment(Cal-PM only) Cal-OMS Admission(Cal-PM only) Cal-OMS Annual Update (Cal-PM only) Cal-OMS Discharge (Cal-PM only) Cal-OMS Youth/Detox Discharge (Cal-PM only) Cal-OMS Administrative Discharge (Cal-PM only) Key Event Tracking Form (Cal-PM only) Partnership Assessment Form (Cal-PM only) Quarterly Assessment Form (Cal-PM only)
ASAM	ASAM Assessment Finalize ASAM Assessment
Patient Notification	Patient Notification Emergency Contact Information Parent/Guardian Information Next of Kin
Member Management	Member Specific Information
Provider Management	Practitioner Enrollment (Brief) Contracting Provider Program Availability Contracting Provider Program Availability Search Provider Activity Authorization Request Performing Provider Registration Contracting Provider Registration
Care Management	Service Authorization Request Contracting Provider Service Authorization Request Provider File Attach
Claims Processing	Batch Creation Claim Processing (CMS 1500) Claim Processing (UB-04) Close Batch 837 Health Care Claim Professional 837 Health Care Claim Institutional Fast Service Entry Submission Retro Claim Adjudication Void Claim Assignment
Provider Management Reports	Provider Listing Report Provider IBNR Authorizations Provider’s Paid Services Provider’s Pended Services Provider’s Denied Services Provider Fee Table Report Authorized Days/Dollars/Code by Provider