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Documents

Medicare Forms | Documents | Links

Forms

Appointment of Representative Form
Care Management Referral Form
Complaint and Appeal Form
Coordination of Benefits Form
Enrollment Form
MedImpact Claim Form

Member Reimbursement Form (Medicare)
Prescription Drug Coverage Determination Request Form
Request for Redetermination of Medicare Prescription Drug Denial Form
Transition of Care/Continuation of Care Request Form
UM Prior Authorization Request Form

Documents

Advance Directive / Living Will / CPR Directive
Glossary of Health Coverage and Medical Terms
LIS Summary Table
Medicare Prescription Transition Process

Medicare Durable Medical Equipment (DME) Providers
Medicare Star Ratings
Provider Directory Tips

Links

Accessing Your Health Information Using Third Party Apps
Affirmative Statement About Incentives
Best Available Evidence
Denver Parks and Recreation Membership
Disaster/Emergency Policy for Medicare Members
Request Copy of Provider or Pharmacy Directory
Lifeline Program
LIS Premium Subsidy
Medicare Appeals and Complaints (Grievances)
Medicare Disenrollment
Medicare Enrollment Instructions

Member ID Card
Member Newsletter
Member Rights & Responsibilities
MyDHMP Member Portal
Services Requiring Prior Authorization
Transportation to Medical Visits
Wellness Blog
Your Dental Benefits
Your Hearing Benefits
Your Vision Benefits

 

Elevate Medicare Advantage is a Medicare-approved HMO plan. Enrollment in Elevate Medicare Advantage depends on contract renewal. The Plan also has a written agreement with the Colorado Medicaid Program to coordinate your Medicaid benefits.

H5608_DHMPWeb25 | Last updated 2/13/25

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