Welcome to the PerformPA Web Submission Form
Using our online web submission form providers will be able to:
- Electronically submit all relevant member information.
- Attach member specific documents such as labs, chart notes, consults etc. (recognized
formats .pdf, .doc, .xls, .ppt, .txt)
- Save unique provider information in order to expedite future web submissions.
- Print summary page for easy referencing.
Please provide as much relevant medication information as possible to increase the
accuracy of your form submission.
Note: Incomplete forms will not be processed.