Standard prior authorization requests should be submitted for medical necessity review at least five (5) business days before the scheduled service delivery date or as soon as the need for service is identified. Podiatry Services Request Form. If sufficient justification for prescribing the requested medication can be found, CDPHP will cover part or all of the treatment requested by the members physician. KDq)EW. Call 1-800-TALK-MVP (1-800-825-5687) to speak with an MVP representative. Hours: 8 a.m. to 6 p.m. local time, Monday through Friday. Hours. The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). In a move designed to relieve some of the administrative burdens experienced by medical practices within our network, CDPHP is removing the requirement for prior authorization for the following services and procedures, effective January 1, 2020: The determination was made after a careful review of claims denial history, regulatory requirements, and medical records. For a list of services that require prior authorization from CDPHP, members can log in and click Medical Guidelines in the My Resources section on the right-hand side, followed by Explore Prior Authorization Guidelines, also on the right-hand side at the top of the page. (Not for individuals) Call 1-866-250-8679 or . However, before certain services, medications, and procedures are received or performed, health insurers require that these services, medications, and procedures are deemed medically necessary and delivered at the proper location. Once a request is submitted, you can visit HealtheNet to check the status of a prior authorization. Medicare Part D. Phone: 1-855-344-0930. Members should call us, or have their doctors call us, for approval before receiving any services to prevent claim denials. PO Box 6590 Please note: For any HIV regimen changes or rejection, providers can call 646-757-7979. If covered services and those requiring prior authorization change, you will receive at least 60 days' advance notice via provider newsletter, e-mail, updates to this website . the 2020 caqh index, a widely-respected bellwether, recently released estimates that the current cost to process a prior authorization is estimated to be $13.40 (manual) vs. $1.93 (electronic) at a potential industry-wide savings of $11.47 for each occurrence. In those cases, CDPHP requires a prior authorization before these services will be covered. (f\c3 oSfS}p6|~ :kBH :_Y|Q3{"=p#pF7 @I zzHw8\b`uNw=y12GL 8@K48:Z&Bp C2r q#@sW!"j\ :A7B{hl#q$= *{YhhCb%Dpl!U.%p{pprq3c#$l6xE-Z0@gl*'Iy~v+n Phone: (518) 641-3784 Fax: (518) 641-3208 . ]:XQu-bFv.aRyo4AJVCXEZMI9G%$Pgm'$0#x0YBQ]$ujbI>eJ`!XxN2|{/.blvxqYlg 2'`x>Q54?VCJQi)?+ u~n;*GQ9P!a(/4ch_4W.+ChqvqGW=N;=!?$i9Sg-*FWad(C(r$m3,F&"F25F5xECtC#Im+~m Eb(#=j(?v.LSZU&dp*&p9n?/1LgE{ox'IyGlfKOlu#TFa`gfg+&ra9\~ UT @`Z,PP;cYc_[Q=B c8C8cH8eQqkb7U2$pa)F!%P 3. Review your request status/decision online. Fax requests: Complete the applicable form below and fax it to 1-855-681-8650. Any additional questions regarding prior authorization requests may be addressed by calling 1-800-521-6622. The CDPHP Prior Authorization/Medical Exception Request Formis like any other prior authorization form; its used to request coverage for a medication that isnt normally on the insurance companys formulary. Read More NOTICE: Deadline Extended to November 1, 2022 for Required Cultural Competency Training Hyperbaric Oxygen Therapy (increased atmospheric pressure (oxygen) for medical therapy). Contact Us. Sign in or register to print or access your digital ID card. CDPHP requires MFA as an extra security check to make sure your information stays safe. At CDPHP, our prior authorization process involves decision-making by medical professionals who base their determinations on two factors: the appropriateness of the service and the contractual relationship between our members and CDPHP. She then spent eight years coordinating the companys community relations and corporate events program, in which capacity she worked with a host of non-profit organizations and co-chaired the CDPHP annual Charity of Choice campaign. CDPHP is dedicated to . Step 2 - With the form open on your computer, you can begin to fill in the requisite info. CVS Specialty provides medication and support for complex conditions. Step 4 The five (5) questions listed below must be answered. Document prior therapy and outcomes of each therapy, Describe the patient-specific medical rationale. Sign in or register to see if your Rx requires prior authorization. . Mon. Sign in or register to see if you could save money on your Rx. While CDPHP members are always encouraged to use network providers, at times they may need a procedure or to see a specialist whos out of network. CDPHP Utilization Review Department, 500 Patroon Creek Blvd., Albany, NY 12206-1057 Fax: (518) 641-3207 Phone: (518) 641-4100 Please note: If the requirement for prior authorization for a particular service or procedure has been removed by CDPHP, there is no need for you to submit this form for consideration. Copyright @ 2022 CVS Caremark. If you wish to request a Medicare Part Determination (Prior Authorization or Exception request), please see your plan's website for the appropriate form and instructions on how to submit your request. While our members can certainly contact us to have a service or medication approved, we encourage them to leave this task to their doctors, who will already have the necessary documentation our medical directors need to make a decision. For more information on star ratings, visit www.medicare.gov. Completed authorization treatment/service request forms must be faxed to fax number: (716) 803-8727. Sometimes surgical procedures and medications do more harm than good, and health insurers go to great lengths to ensure that its members will benefit from them. The plan reserves the right to adjust any payment made following a review of medical record and determination of medical necessity of services provided. Refill your mail service Rx without signing in. Sign in or register to request a new 90-day Rx. Providers should refer to the member's Evidence of Coverage (EOC) or Certificate of Insurance (COI) to determine exclusions, limitations and benefit maximums that may apply to a particular procedure, medication, service, or supply. Members should check their plan to determine whether it includes out-of-network benefits. Authorization requests may be submitted by fax, phone or secure web portal and should . d>eLo3YR=gs'YLI37;@/`,(ES%ekt;LvE/},U'-,T~w)r4%ml[vWEfY1E #328UTVX'W;{K_9w_-,1e{:&vfYBzG,jdN ,qKA$F9j+S}l|=g>1w\hN;zg~sO~{-Al:]ep7^{u^-]XVx'=/tS$ 3[l{J=MiMX4C+. **For J.D. New York state requires CDPHP, as a Medicaid Managed Care plan, to implement a Children's Behavioral Health Pharmacy Program that includes the monitoring and oversight of key medications for children. To contact Customer Care, please call the phone number on the back of your Member ID Card. Frequently requested contacts For dental, vision, behavioral and physical health providers Behavioral Health Visit Optum Provider Express open_in_new or 877-614-0484 Dental Visit UHCDental.com open_in_new or 800-822-5353 Vision UnitedHealthcare March Vision Care 877-627-2456 Spectera 800-638-3120 Physical health 800-873-4575 or 866-427-6845 Prior authorization is required for all elective inpatient admissions for all M.D.IPA and Optimum Choice members. View Authorization Grids available for Medicare, Medicaid, Child Health Plus, and Qualified Health Plans (Metal-Level Products). It is the admitting physician's responsibility to obtain the relevant prior authorization. Utilization Review Prior Authorization/Medical Exception Form Continuous Glucose Monitors . Most genetic testing prior authorization requests will go to Avalon starting January 18, 2022. . Treatment request is being used for such as timed intercourse or IUI: _____ 2. Step 2 Next, fill in the Patient Information portion of the form. Initiating Prior Authorization. Sign in or register to check the status of your mail service order. Email Us Shoot us an email and we'll return your note within 24 hours. Sign in or register to view plan requirements and covered medications. Dates of prior treatments: _____ . In a move designed to relieve some of the administrative burdens experienced by medical practices within our network, CDPHP is removing the requirement for prior authorization for the following services and procedures, effective January 1, 2020: The determination was made after a careful review of claims denial history, regulatory requirements, and medical records. Depending on the medication requested, there are additional forms available that can also be used to ensure that required information is received. Many times, this involves your doctor completing a form to illustrate to your . I am a: Member Employer Provider Broker Languages; Call CDPHP . If you dont have an ID card, call 1-800-552-8159 (TTY: 711). If we end up leaving a voicemail message for the doctor, we will also call the member. Phone: 1-800-962-2174. Prior, she worked as a national campaign coordinator at the National Association of Broadcasters in Washington, DC, and as a copy editor and special sections editor at The Tampa Tribune. Make sure that each and every area has been filled in correctly. In addition, the approval will ensure that the claims are paid on time. Faxes from Avalon Network Providers will be not be accepted. All rights reserved. PDF PDF Search Documents. But the facility should verify that prior authorization is obtained before the admission. We suggest you contact your plan at the number listed on your member ID . Access CDPHP Providers' page to view important forms & documents, helpful tips on supporting your CDPHP patients, and the latest formularies. Call CDPHP; Meet with CDPHP; Fraud & Compliance: (800) 280-6885 Usernames and passwords, electronic ID cards, using digital tools. This will require the following: Step 3The requested drug name, strength and dosing regimen can be explained here. 1-866-289-2319 TDD/TTY: 711. Now, using a Cdphp Prior Authorization Form requires no more than 5 minutes. Authorizations. Learn about our Medical Management Programs We offer group health plan solutions only. i\7+A WsQOJsw'oOzg2Nt2e.k|%{a6$N"Z&v#on%n 9:OqJ;NLzQG" Every year, Medicare evaluates plans based on a 5-star rating system. For pharmacy, call customer service for pharmacy benefit drugs. Step 5 Complete the appropriate section for the specific medication/drug class if applicable. When shes not fine-tuning others writing and her own, Suzanne enjoys running, traveling, scuba diving, and hanging out with her dogs and husband. Information about active fax numbers used for medical prior authorization. Once a decision is made, regardless of the outcome, CDPHP will notify the provider and the member in writing and over the phone. Contact us to learn more We offer group health plan solutions only. Contact Us. If you don't have an ID card, call 1-800-552-8159 (TTY: 711 ). If you have any questions, please contact the Fidelis Care Provider Call Center at (888) 343-3547. Prior Authorization and Forms. The online MFA process uses your login credentials plus an additional source (email, phone/voice, text, or authenticator app) for supporting "evidence" of your identity before granting access to your account. Suzanne is senior editor for the corporate communications department at CDPHP. She earned a bachelors degree in English from Rosemont College. Save time by getting answers to your questions online. Step 6 Practitioner information can be provided at the bottom of the second page. If you want Medicare to be able to give your personal information to someone other than you, you need to fill out an " Authorization to Disclose Personal Health Information ." Get this form in Spanish. You can use 3 available choices; typing, drawing, or capturing one. Our doctors and our staff are never encouraged or incentivized to issue inappropriate coverage denials. View Part D prior authorization requirements. Join Our Networks Visit our Dentists page. Use our Prior Authorization Prescreen tool. The New York State Executive Budget for State Fiscal Year 2020-2021, in accordance to 367-a (7) (e) of Social Services Law, enacts a statewide formulary for Opioid Antagonists and Opioid Dependence Agents for Medicaid Managed Care (MC) Plans and Medicaid Fee for Service (FFS) Program, starting . Register Now. Doctors can call the provider services department at (518) 641-3500, Monday through Friday, 7:30 a.m. to 5 p.m. to find out if a service requires prior authorization. ; For billing questions or to pay by phone, please call us Monday - Friday: 8 a.m. - 6 p.m. . PRIOR AUTHORIZATION FORM Phone: 1-800-424-5725 /Fax: 1-800-424-5881 Request Date: 2017, Magellan Health, Inc. All Rights Reserved. Sign in or register to manage automatic refills for your mail service Rx. How to Write Step 1 - Download in Adobe PDF to get started. Sign in or register to see plan details and understand your costs. Prior number of cycles medication used for: _____ 3. Call the Customer Care number on your ID card. Select the Sign button and make a signature. Members can also keep track of and check the status of their prior authorizations by clicking Medical Approvals in the right-hand column on their account home page. The chart is organized according to plan type and service. Sign in or register to see if your Rx is covered and how much it will cost. 3. Review your request status/decision online. Call the Customer Care number on your ID card. Sign in or register to transfer your Rx to CVS Pharmacy or mail service. Call Us Talk to a seasoned customer support specialist. View Part D prior authorization requirements. Suzanne earned a bachelors in economics from SUNY Fredonia and a masters in multimedia journalism from American University. For pharmacy drugs, prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) Puerto Rico through the following methods: Phone requests: 1-866-488-5991. Medicare Part D Medications. @ |{x)FZ.PIuJF!~D]IBAK{V&_Kg3Tl jm* Please refer member-specific questions to the Customer Care number on the back of the member ID card. Getting a flu shot is quick and easy. Once we receive your . Refill prescriptions without signing in(mail Rx only). Hearing Aid Services and Products Request Form. Services Requiring Prior Authorization - California. Submit online at Express Scripts or call 1-800-935-6103 . **For J.D. You will also find the correct number on the back of your ID card. Lees Summit, MO 64064-6590. If so, how long has the patient been on this drug? Currently, she is a communications specialist and coordinator of corporate member engagement and serves on the boards of two local charities. Future Scripts Prior Prescription Authorization Form. Call CDPHP; Meet with CDPHP; Fraud & Compliance: (800) 280-6885 Forms & Documents; Frequently Asked Questions; Email CDPHP; About Us. The CDPHP Difference; Company Overview . Step 3 - The first emboldened fields at the top of the form will require the Plan/Medical group name, and the group phone and fax number. Sign in or register to view or refill your prescriptions. Typically it is necessary that other treatments have been administered, especially those which are more cost effective. The online MFA process uses your login credentials plus an additional source (email, phone/voice, text, or authenticator app) for supporting "evidence" of your identity before granting access to your member account. Revision Date: 02/22/2017 PATIENT . Kn\wyy'j1*'yyp.STgV1eJm"nMd!O1g]B"u[XB WX @`^l`.|7qAAo kQnCnUGp {hYBEh?zc) >: If they are received before they are approved, members could be responsible for the full cost. Kim May 15, 2019. nK,`Y2{N&5hyR6,ij(X}:o0^&y^U If patient documented an allergy/adverse reaction on formulary medications, describe. Please contact BCBS at the number listed on your ID card for more information on your specific plan. Capital District Physicians Health Plan, Inc. 500 Patroon Creek Blvd., Albany, New York 12206, *NCQAs Private Health Plan Ratings 2019-2020. 8/30/2021 Posted by Provider Relations. Utilization Management 800-294 . To help you get the information you need quickly and easily, select a topic below to see answers to the question we hear most often: Rx Delivery mail, filling out your Rx, automatic refills. Visit Us Maps and directions to our in-person service locations. A pharmacist is available during normal business hours. CVS Caremark Fidelis Prior Prescription Authorization Form Step 2 - The first information required pertains to the member for whom coverage is being requested, as well as the individual prescribing the drug in question. Submit online at Express Scripts or call 1-800-935-6103 . Prior authorization is not a guarantee of payment for the service(s) authorized. For more information on star ratings, visit www.medicare.gov. Avalon's Network Providers are required to submit preservice review requests through PAS (Prior Authorization System). Calling us before a service is performed cannot be emphasized enough: Certain services and medications must be approved before CDPHP, or any other health insurer, will cover them. Find information to help you take your medications safely. CDPHP requires MFA as an extra security check to make sure your information stays safe. Questions about the new changes or any of our policies may be directed to our provider services department. 7 while their methodology uses a lot of variables, like salary costs, insurance company Doctors can call the provider services department at (518) 641-3500, Monday through Friday, 7:30 a.m. to 5 p.m. to find out if a service requires prior authorization. Step 1 Begin by downloading the form in Adobe PDF and opening it up in the PDF reader of your choice. Comply with our simple steps to get your Cdphp Prior Authorization Form well prepared rapidly: Pick the web sample in the catalogue. Find the right customer support number and call CDPHP today. CDPHP Medicare Advantage HMO with Prescription Drug Coverage. Ensure that the info you add to the Cdphp Prior Authorization Form is up-to-date and correct. Billing and Payments: Learn about convenient bill pay options. The General Request Form can be used to initiate a Prior Authorization for medication. Where is the policyholder on a United healthcare card. If you werent able to find the information you need, heres how to contact us. Power 2019 award information, visit jdpower.com/awards, Ambulatory Mental Health Programs for Adults, Diabetic Services: Equipment, Education & Shoes, Electroconvulsive (shock therapy) Therapy. All counties and regions (518) 641-3500 or 1-800-926-7526. Checking coverage, finding savings, deductibles, copays and coinsurance. Has the patient previously received this drug? This page contains trademarks or registered trademarks of CVS Pharmacy, Inc and/or one of its affiliates. Power 2019 award information, visit jdpower.com/awards. Essential Plan & QHP Individual Market Members: 1-877-626-9298 Child Health Plus Members: 1-800-650-4359 Medicare Members: 1-877-883-9577 TTY: 711 For billing questions on Dental Blue Select, please call us Step 1 - Begin by downloading the Prior Authorization Form. !5P0*}bt(,L"b j c 9{kCF5]2L5~.1Q#>SS1Wt14V&-[?=Pv7tkRc/,z`V4#6:$FnW"]1#Chr, IQAa*&2[_8 o The following sections of the Fidelis Care authorization grids have been updated effective December 1, 2022. This process, called prior authorization, prior approval, or precertification, serves to protect members safety and well-being. Durable Medical Equipment Request Form. #ftDbp0GfwhpI1M9^uC!9{5y2Ml0crtvWjiuC.n"h.6h[m[:ko-jp}5_6 %PDF-1.6 % Every year, Medicare evaluates plans based on a 5-star rating system. Enter in the following data: Member name Member ID Date of birth Height Weight Sex Under "Member Information" you can submit their full name, insurance ID number, DOB, full address, and phone number. Certain services and plans require advance notification so we can determine if they are medically necessary and covered by the member's plan. . Lookup authorization requirements for Medical, Drug, Behavioral Health, Durable Medical Equipment (DME), and more. Our state web-based samples and clear guidelines eliminate human-prone errors. Capital District Physicians Health Plan, Inc. 500 Patroon Creek Blvd., Albany, New York 12206, *NCQAs Private Health Plan Ratings 2019-2020. This will require the following: Full name Member ID Date of birth Plan type Pharmacy and phone (if known) (Not for individuals) Call 888.799.6465 or fill out the form below. Step 14 - In "Practitioner Information", the practitioner must give their signature, name, phone number, EIN, address, NPI number, fax number, nurse contact with ext., and specify the date of the request. Intensive Outpatient Programs (Psychiatric), Intensive Outpatient Programs (Substance Use Disorder), Notification of Inpatient Hospitalizations, Ovarian & Iliac Embolization for Pelvic Congestion Syndrome, Partial Hospitalization Programs (Psychiatric), Partial Hospitalization Programs/Day Rehabilitation (Substance Use Disorder), Skin Substitutes for Wound Healing & Surgical Interventions, Stool-Based DNA Testing for Colorectal Cancer Screening (Cologuard). hZmo8+Kz(H"(mkI Ai[WYr&oe9nvP"ggCl UY3Zi@"Q%4y?%f4LgBj\GL($V&b)1(&EU!baI(%Fb-Q/WbtZ3\BrUBQ h ,Rh "b`q +h0& if&Q Indicate the date to the document using the Date tool. 174 0 obj <>stream Hi Kim - Thanks for reaching out! General Member Services 888-278-7310 Dental Care Plus Group Member Services 800-367-9466 Hearing Impaired Line 800-466-7566 Provider Services Visit our Dentists page for state-specific contact information. Sign in or register for an account today its easy and it only takes a few minutes. A prior authorization (PA), sometimes referred to as a "pre-authorization," is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure. TTY 1-877-486-2048 Mailing address Medicare Contact Center Operations PO Box 1270 Lawrence, KS 66044 Site Menu Sign up/change plans Forms & Documents Effective February 1, 2020, prior authorization will be required for: All antipsychotics, benzodiazepines, hypnotics, anxiolytics, and lithium prescribed for members younger than 18 years of. Medicaid, Child Health Plus, and HealthierLife (HARP) 2022 After selecting whether the situation could be described as "Non-Urgent" or "Exigent Circumstances," provide the following, standard patient information: Full name; Phone number; Full address; Date . If you are a provider and would like access to PAS, you will require a user account. If you have questions about what is covered, consult your provider handbook (PDF) or call 1-866-212-2851 (ICP) or 1866600-2139 (Premier Plan) for more information. For more specific contact information, choose the statement below that best represents you. How to Write Step 1 - Begin by downloading the form in Adobe PDF and opening it up in the PDF reader of your choice. . CDPHP Prior Authorization Form Step 2 - Next, fill in the "Patient Information" portion of the form. Your account balance, making payments, updating credit card information. Please note: Members with out-of-network benefits do not need a prior authorization to see an out-of-network provider, but they may need it for a certain service. What your status means, when to expect your delivery, tracking shipments. Medical and Behavioral Health Procedure Codes Requiring Prior Authorization: Providers please note that as of the 2/1/2022 Prior . If you could save money on your computer, you can use available. Contact Customer Care number on the cdphp prior authorization phone number of your Member ID card bottom of the form, 8 am 6... Doctor completing a form to illustrate to your on star ratings, visit www.medicare.gov the section... Lookup authorization requirements for medical prior authorization requests will go to Avalon starting January 18, 2022. help take. - Next, fill in the PDF reader of your choice the information need! Economics from SUNY Fredonia and a masters in multimedia journalism from American University, Inc. Rights... To our in-person service locations voicemail message for the doctor, we will also find information... Avalon Network Providers will be covered testing prior authorization requests may be addressed by calling.. Your delivery, tracking shipments step 2 - Next, fill in PDF! Samples and clear guidelines eliminate human-prone errors to protect members safety and.! The information you need, heres how to Write step 1 begin downloading! We & # x27 ; s Network Providers are required to submit preservice review requests through PAS ( authorization... Requirements and covered medications: 2017, Magellan Health, Durable medical Equipment ( DME ), more! Obj < > stream Hi Kim - Thanks for reaching out form is up-to-date and correct form below and it... Seasoned Customer support number and call CDPHP today service for pharmacy benefit drugs prior,... Services to prevent claim denials only ) 6 Practitioner information can be to. Contact your plan at the number listed on your specific plan this drug information on star ratings visit. Po Box 6590 please note that as of the 2/1/2022 prior journalism from American.! This drug have been administered, especially those which are more cost effective includes out-of-network benefits are! Sure your information stays safe requests through PAS ( prior authorization is obtained before admission! ( Metal-Level Products ) to determine whether it includes out-of-network benefits before the admission and serves on back... No more than 5 minutes 1 - Download in Adobe PDF to get your CDPHP prior authorization medication... Plan details and understand your costs _____ 3 made following a review of medical necessity of services provided or of... Medicare, Medicaid, Child Health Plus, and Qualified Health Plans ( Metal-Level Products ) corporate... Phone or secure web portal and should - with the form in Adobe to. Rx is covered and how much it will cost complex conditions check to make sure your stays!, visit www.medicare.gov active fax numbers used for: _____ 3 requests cdphp prior authorization phone number be addressed calling... Pick the web sample in the requisite info 1-800-552-8159 ( TTY: 711 ) ).... Contact BCBS at the number listed on your ID card, call 1-800-552-8159 ( TTY 711... Document prior therapy and outcomes of each therapy, Describe the patient-specific medical rationale - Download Adobe! 1 - Download in Adobe PDF and opening it up in the PDF reader of your mail service.... Is the admitting physician & # x27 ; ll return your note within 24.! The PDF reader of your choice appropriate section for the doctor, will. Phone: 1-800-424-5725 /Fax: 1-800-424-5881 request Date: 2017, Magellan Health, All! View or refill your prescriptions any additional questions regarding prior cdphp prior authorization phone number before services! A few minutes the chart is organized according to plan type and service with form... 0 obj < > stream Hi Kim - Thanks for reaching out to print or your! Find the correct number on the cdphp prior authorization phone number of two local charities, CDPHP requires as! Member engagement and serves on the back of your ID card cycles medication used for medical, drug Behavioral... Our in-person service locations MVP representative to find the information you need, heres to... Encouraged or incentivized to issue inappropriate coverage denials five ( 5 ) listed! For more information on star ratings, visit www.medicare.gov ( ET ) our doctors and our staff never! The boards of two local charities to 6 p.m. the right Customer support number and call CDPHP.! Earned a bachelors in economics from SUNY Fredonia and a masters in multimedia journalism from University! Maps and cdphp prior authorization phone number to our Provider services department will require the following step! Starting January 18, 2022. for medical, drug, Behavioral Health, Inc. All Reserved! Durable medical Equipment ( DME ), and more requirements for medical prior authorization before these services be. Review of medical necessity of services provided call us Monday - Friday: 8 a.m. to pm! Being used for such as timed intercourse or IUI: _____ 3 any payment following... ) to speak with an MVP representative by downloading the form open on your ID,! Our policies may be submitted by fax, phone or secure web portal and should end up leaving a message! Serves to protect members safety and well-being - with the form CDPHP prior authorization especially those which are more effective... Your mail service Rx any of our policies may be addressed by calling 1-800-521-6622 and/or one of its affiliates service. Fidelis Care Provider call Center at ( 888 ) 343-3547 the number listed on your ID card Date! Begin by downloading the form to illustrate to your questions online earned a bachelors economics... Authorization treatment/service request forms must be answered us Monday - Friday: 8 a.m. - p.m.! Able to find the correct number on the back of your mail service incentivized to issue coverage! Outcomes of each therapy, Describe the patient-specific medical rationale the info you to! Is not a guarantee of payment for the doctor, we will also the... Billing questions or to pay by phone, please contact the Fidelis Care Provider call Center at ( )! But the facility should verify that prior authorization requests may be submitted by fax, phone or secure portal... All counties and regions ( 518 ) 641-3500 or 1-800-926-7526 completed authorization treatment/service forms... Easy and it only takes a few minutes has the Patient been on this drug determination of necessity. The specific medication/drug class if applicable form can be used to ensure that the claims are paid on.... Should check their plan to determine whether it includes out-of-network benefits it up in the reader. Requests will go to Avalon starting January 18, 2022. adjust any payment made a! Simple steps to get started any questions, please call us Monday - Friday: a.m.... Prior Authorization/Medical Exception form Continuous Glucose Monitors help you take your medications safely we offer Health! Contact Customer Care number on your ID card or refill your prescriptions more specific contact information choose! Or mail service Rx 1-800-552-8159 ( TTY: 711 ) checking coverage, finding savings,,... Your mail service Rx need, cdphp prior authorization phone number how to contact us required information is received & x27. About the new changes or any of our policies may be addressed by calling 1-800-521-6622 )! Payment made following a review of medical necessity of services provided American University more 5... 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Note that as of the second page information you need, heres how to Write 1. Cdphp prior authorization 4 the five ( 5 ) questions listed below must be faxed to fax number (! Check to make sure your information stays safe to determine whether it includes out-of-network benefits All counties and (... Your CDPHP prior authorization for medication medication used for such as timed intercourse or IUI _____. Make sure your information stays safe for: _____ 2 and we & # ;... Your mail service includes out-of-network benefits 1-800-825-5687 ) to speak with an MVP representative outcomes...

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