Forms
- Authorization to Use and Disclose PHI
- Medimpact Claim Form
- Prescription Drug Coverage Determination Request
- Coordination of Benefits
- Member Reimbursement Form (Medicare)
- Request for Redetermination of Medicare Prescription Drug Denial Form
- Medicare Appointment of Representative
- Pharmacy Prior Auth Request (PAR) / Exception Request Form
- UM Prior Authorization Request
- Medicare Complaint & Appeal Form (Request for Reconsideration)
Documents
Links
- Affirmative Statement About Incentives
- How to Request Hard Copy of Provider or Pharmacy Directory
- Medicare Disenrollment
- Best Available Evidence
- LIS Premium Subsidy
- Medicare Enrollment Instructions
- Denver Parks and Recreation Membership
- Medical Prior Authorization List
- Member Rights & Responsibilities
- Glossary
- Medicare Coverage Decisions, Appeals and Grievances