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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

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Medicare Advantage Provider Forms


Beneficiary Notice Forms  
Medicare Part D Rx Coverage Determinations and Appeals 
Providers can send a request for a prescription coverage determination or an appeal for a Medicare plan via email rather than fax or phone by sending the request to the following address:  
General Correspondence  
General Correspondence Form
To be used for Corrected Claims, Coverage Verification, Explanation of Benefits, Prior Authorization 

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