Publications and Forms
If you need a publication or form that is not available here, please contact Provider Relations.
2023 Plan Publications
- 2023 Summary of Benefits
- 2023 Quality and Performance Ratings (Every year, Medicare evaluates plans based on a 5-star rating system.)
- 2023 Annual Notice of Changes (ANOC)
- 2023 Evidence of Coverage
- 2023 Comprehensive Formulary (effective January 1, 2023; last updated October 7, 2022)
- 2023 Prescription Drug Prior Authorization Criteria (effective January 1, 2023; last updated November 14, 2023)
- 2023 Prescription Drug Step Therapy Criteria (effective January 1, 2023; last updated November 14, 2023)
2022 Plan Publications
- 2022 Summary of Benefits
- 2022 Quality and Performance Ratings (Every year, Medicare evaluates plans based on a 5-star rating system.)
- 2022 Annual Notice of Changes (ANOC)
- 2022 Evidence of Coverage
- 2022 Comprehensive Formulary (effective December 1, 2022; last updated November 23, 2022)
- 2022 Prescription Drug Prior Authorization Criteria (effective December 1, 2022)
- 2022 Prescription Drug Step Therapy Criteria (effective December 1, 2022)
Provider Directories
- Search online using our Network Provider/Facility/Pharmacy Search application
- Provider and Part B Pharmacy Directory (last updated January 1, 2023)
- Part D Pharmacy Directory (last updated January 1, 2023)
| To report any errors in the PHP provider or pharmacy, please send an email to [email protected]. You may also report directory errors by calling Provider Relations at (888) 726-5411 between the hours of 8:00 am to 8:00 pm, Monday through Friday. |
Provider Publications and Documents
- Home Health PPS Claims Job Aid
- Home Health OASIS Assessment Job Aid
- Home Health Notice of Admission (NOA) Job Aid
- CMS Glossary and Acronym List Job Aid
- Corrected Claim Guidelines
- Paper Claim – Return Mail Notice
- Delegated Roster Template
- Quick Reference Guide
- Improving HEDIS Scores
- Homeless Provider Communication
- NPI Tax ID Flyer
- Waiver of Liability Statement
- Prescription Drug Authorization Request
- Authorization Request Form
- Provider Claims Dispute Submission Form
- Provider Grievance Form
- Injectable Drugs Requiring Pre-Service Approval (last updated May 1, 2013)
- California Pre-Service Injectable Drug Authorization Request
- 2018 Model of Care Summary
- 2014 Cultural & Linguistics Program
- PHP Provider Manual
You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.
