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 Change (ANOC)
- 2023 Evidence of Coverage
- 2023 Comprehensive Formulary (effective May 1, 2023; last updated April 25, 2023)
- 2023 Prescription Drug Prior Authorization Criteria (effective May 1, 2023; last updated April 25, 2023)
- 2023 Prescription Drug Step Therapy Criteria (effective May 1, 2023; last updated April 25, 2023)
Provider and Pharmacy Directories
- Search online using our Network Provider/Facility/Pharmacy Search application
- Provider and Part B Pharmacy Directory – Broward and Miami-Dade Counties (last updated April 1, 2023)
- Provider and Part B Pharmacy Directory – Duval County (last updated April 1, 2023)
- Part D Pharmacy Directory – Broward and Miami-Dade Counties (last updated April 1, 2023)
- Part D Pharmacy Directory – Duval County (last updated April 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
- NPI Tax ID Flyer
- Provider Manual (last updated May 31, 2019)
- Provider Quick Reference Guide to PHP Florida
- 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)
- Florida Pre-Service Injectable Drug Authorization Request
- 2018 Model of Care Summary
- 2014 Cultural & Linguistics Program
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.
