2008 Provider Directory:

2008 Drug Formulary

• Drug Formulary

2008 Summary of Benefits

• Platinum Plan

• Dual Plus Plan

• Medicare Advantage Plan

2008 Low Income Subsidy Premium Information

2008 Evidence of Coverage

• Platinum Plan

• Dual Plus Plan

• Medicare Advantage Plan

2008 Medicare Forms

• Enrollment Form

• Prior Authorization (Redetermination Request) Form:

  • Members: To request assistance with a prior authorization, please call Care1st Member Services at 1-800-544-0088. TTY users should call 1-800-735-2929.

  • Physicians

• Treatment Authorization Request Form

• Special Medical Records Release Form

Appeals and Grievances

• Grievances

  • Grievance Instructions and Form

  • Obtaining Aggregate Numbers

• Appeals
  

  • Appointment of Representative Form

• How to Appoint a Representative

• Written Request for an Appeal

• Summary: Part C Appeals Process

• Summary: Part D Appeals Process

Refer to the Evidence of Coverage for information about:

• Part C organization determinations - SECTION 9

• Part C grievances - SECTION 8

• Part C appeals - SECTION 9

• Part D coverage determinations - SECTION 10

• Part D grievances - SECTION 8

• Part D appeals - SECTION 10

For questions about the appeals, grievances and exceptions processes, please call:

• Members:
  For all inquiries:
  Care1st Member Services
  1-800-544-0088 (TTY 1-800-735-2929).

• Physicians:
  Appeals & Grievance Inquiries:
  Care1st Member Services
  1-800-544-0088 (TTY 1-800-735-2929)
  

• Pharmacy Inquiries:
  1-877-RXCARE1 (1-877-792-2731)
  

• UM Inquiries:
  1-800-468-9935