Healthy Indiana Plan. Browse commonly requested forms to find and download the one you need for. Prenatal. Coverage Programs. . Submit the IMRT Pre-authorization Request Supplement Form (PDF) when requesting pre-authorization for these services. IHCP Prior Authorization Request Form Version 7. Oct 1, 2020 · On January 1, 2021, Anthem Blue Cross and Blue Shield prior authorization (PA) requirements will change for codes below. . Updated June 02, 2022. Prior Authorization Request Form. April 2017.
. • Call Provider Services Monday through Friday, 8 a. . Forms and Guides; Policies, Guidelines & Manuals; Provider Maintenance; Pharmacy; Behavioral Health; Dental; Vaccination Resources; Find Care; Availity; Claims Claims.
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. . aspx • PA forms: https://mediproviders. 7. Medicare $0. . Step 4: Within the tool, select Send Attachment then Predetermination Attachment.
Send all listed documentation with the SUD PA form. Under the fee-for-service (FFS) delivery system, decisions to authorize, modify or deny requests for PA are based on medical. . Prior Authorization. m.
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Disease/Drug Specific Prior Authorization Forms. . Disease/Drug Specific Prior Authorization Forms. At Anthem, we're committed to providing you with the tools you need to deliver quality care to our members.
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Important Legal Information:: Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage, Highmark Benefits Group, Highmark Senior Health Company, First Priority Health and/or First Priority Life provide health benefits and/or health benefit administration in the 29 counties of. . com/in/pages/forms.
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As a health care consumer, and HealthLink member, you have certain rights and responsibilities when it comes to the quality of care you receive from providers, your health plan benefits and your private health. Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit.
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All questions related to payments and statements made prior to October 1, 2019, should be faxed to. Visit the Independence Blue Cross medical policy page for more information. . 7.
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Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit. Email Ascension Care Management Insurance Holdings at shp-authorization. . Looking for a form but don’t see it on this page? Please contact your provider.
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That's why we have a team of experts and a variety of help resources to make requests faster and easier. Nov 9, 2022 · Ascension Complete Claim Dispute and Reconsideration Form (PDF) - last updated Nov 9, 2022. Health insurance can be complicated—especially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification).
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May 11, 2023 · Behavioral Health Additional Forms: Provider Specialty (PDF), and HSPP Attestation (PDF) Behavioral Health Facility and Ancillary Demographic Form (PDF) Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect Hospital and Ancillary Credentialing Form (PDF) IHCP Practitioner Enrollment Form (PDF) Non Contracted Provider Set-Up Form.
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April 2017. Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are. . April 2017.
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. Please fill out the Prescription Drug Prior Authorization Or Step Therapy Exception Request Form and fax it to (844) 474-3347. . Claims Submission; Electronic Data Interchange (EDI) Prior Authorization; Patient Care Patient Care.
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Coverage Programs. 1 - CoverMyMeds Provider Survey, 2019. .
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. Network (s) Expedited Pre-service Clinical Appeal Form. On January 1, 2021, Anthem Blue Cross and Blue Shield prior authorization (PA) requirements will change for codes below. Use black or blue ink to ensure the scanner can read the claim.
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• Pharmacy prior authorizations: Call Provider Services lines Hoosier Healthwise —1-866-408-6132 Hoosier Care Connect —1-844-284-1798 Healthy Indiana Plan —1-844-533-1995 Providers can submit prior authorization requests for any prescription drugs that require prior authorization to Anthem. m. . Medicaid only (BCCHP and MMAI).
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aspx • PA forms: https://mediproviders. Sep 9, 2022 · Access behavioral health forms for providers at MHS Indiana like the Behavioral/Physical Health Form, Outpatient Treatment Request forms, and more.
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Use our Find a Doctor tool. Visit the Independence Blue Cross medical policy page for more information. Send the original claim form to Anthem and retain a copy for your records.
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Hoosier Healthwise and Health Indiana Plan: 1-866-408-6131; TTY 711 Hoosier Care Connect: 1-844-284-1797; TTY 711 Get the mobile app Let’s make healthy happen.
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Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be. For questions or issues with the CenterX, please reach out to your EMR vendor. Select your state below to view forms for your area. Our clinicians are available 24 hours a day, 7 days a week to talk with you and give the assistance you need.
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m. . For questions or issues with the CenterX, please reach out to your EMR vendor. 1, 2021 — This notice was posted Oct. .
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All Networks: Uniform Prior Authorization Form: Commercial Only: Uniform Prior Authorization Form: Medicaid (BCCHP Only: Synagis Prior Authorization Form: Medicaid (BCCHP only). Welcome, providers! Resources that help healthcare professionals do what they do best — care for our members.
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Complete the SUD PA request form in its entirety. 7. No hold times. . • Pharmacy prior authorizations: Call Provider Services lines Hoosier Healthwise —1-866-408-6132 Hoosier Care Connect —1-844-284-1798 Healthy Indiana Plan —1-844-533-1995 Providers can submit prior authorization requests for any prescription drugs that require prior authorization to Anthem.
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. •Providers may call Anthem to request prior authorization for inpatient. •Providers may call Anthem to request prior authorization for inpatient health services using the following phone numbers: Hoosier Healthwise: 866-408-6132 Healthy Indiana. .
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Learn more today. Ask your provider to go to Prior Authorization Requests to get forms and information on services that may. Use the.
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. Call our Behavioral Health Crisis Line at 833-874-0016.
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to 2 p. Visit the Independence Blue Cross medical policy page for more information. Browse commonly requested forms to find and download the one you need for. Use the correct form and be sure the form meets Centers for Medicare & Medicaid Services standards.
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Ask your provider to go to Prior Authorization Requests to get forms and information on services that may. Select your state below to view forms for your area.
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Learn more. . Our electronic prior authorization (ePA) solution is HIPAA compliant and available for all plans and all medications at no cost to providers and their staff. Form Title.
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April 2017. Provider Authorization [590 Program membership information for outside the 590 Program facility] – State Form 15899 (R5/10-18)/OMPP 2021.
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Send documentation that supports the six dimensions of ASAM to support the level. Legal Information. . Disease/Drug Specific Prior Authorization Forms.
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This form allows members who are enrolled in a Horizon BCBSNJ commercial product, and are age 62 years or older, to designate an additional person to receive a copy of certain notices. Call our Behavioral Health Crisis Line at 833-874-0016. Our clinicians are available 24 hours a day, 7 days a week to talk with you and give the assistance you need. Pre-certification required.
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login • Universal PA form:. m. .
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When required, beginning April 1, 2021, color dose volume histograms must be in color. Step 2: Select Claims & Payments from the navigation menu. Medical clearance forms and certification of medical necessity forms required with certain PA requests (as well as the PA request forms.
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m. . m. Our electronic prior authorization (ePA) solution is HIPAA compliant and available for all plans and all medications at no cost to providers and their staff.
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. . All Networks: Uniform Prior Authorization Form: Commercial Only: Uniform Prior Authorization Form: Medicaid (BCCHP Only: Synagis Prior Authorization Form: Medicaid (BCCHP only). Sep 9, 2022 · Access behavioral health forms for providers at MHS Indiana like the Behavioral/Physical Health Form, Outpatient Treatment Request forms, and more.
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. General Specialty Prior Authorization Form (PDF) Medication Prior Authorization Form (PDF) Request a Drug to Be Added to the PDL (PDF) To request a printed copy of one of these forms, please call Provider Services. m. m.
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AmeriHealth Administrators, an independent company, performs medical management services on behalf of Independence Administrators. Enrollment/Discharge/Transfer (EDT) State Hospitals and 590 Program – State Form 32696 (R3/2-16)/OMPP 0747. your PA request, call us at 1-844-533-1995 for members enrolled in Healthy Indiana Plan, 1-844-284-1798 for members enrolled in Hoosier Care Connect and 1-866-408-6132 for. 962.
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Oct 1, 2020 · On January 1, 2021, Anthem Blue Cross and Blue Shield prior authorization (PA) requirements will change for codes below. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. ET.
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To request prior authorization, contact Companion Benefits Alternatives (CBA) using one of the below options: Calling 800-868-1032. All Forms & Guides.
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May 11, 2023 · Behavioral Health Additional Forms: Provider Specialty (PDF), and HSPP Attestation (PDF) Behavioral Health Facility and Ancillary Demographic Form (PDF) Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect Hospital and Ancillary Credentialing Form (PDF) IHCP Practitioner Enrollment Form (PDF) Non Contracted Provider Set-Up Form. com/availity/web/public.
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Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage.
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m. Forms Library. . Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect Prior authorization (cont.
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. . LET’s GET STARTED. 7. Forms. Table 2 – IHCP Prior Authorization Request Form. If you have questions regarding your PA request, call us at 1-844-533-1995 for members enrolled in Healthy Indiana.
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View the status of an authorization by visiting the clinician portal; By Fax. May 11, 2023 · Behavioral Health Additional Forms: Provider Specialty (PDF), and HSPP Attestation (PDF) Behavioral Health Facility and Ancillary Demographic Form (PDF) Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect Hospital and Ancillary Credentialing Form (PDF) IHCP Practitioner Enrollment Form (PDF) Non Contracted Provider Set-Up Form. Third Party Designee Appointment / Acceptance. We’ve provided the following resources to help you understand Anthem’s prior authorization process and obtain authorization for your patients when it’s.
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Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit. . Send the original claim form to Anthem and retain a copy for your records. This includes selecting the correct drug in the “Authorization Lines” section.
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The Sydney Health app makes it easy to find a doctor, access your ID card, chat with a live representative, and more. No hold times.
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Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. 01 Provider Flyer (PDF) - last updated Jun 28.
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ET Monday – Friday and Saturday from 10 a. To help us expedite your authorization requests, please fax all the information required on this form to 1-844-864-7860.
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. AmeriHealth Administrators, an independent company, performs medical management services on behalf of Independence Administrators. . Enrollment/Discharge/Transfer (EDT) State Hospitals and 590 Program – State Form 32696 (R3/2-16)/OMPP 0747.
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Sep 9, 2022 · Access behavioral health forms for providers at MHS Indiana like the Behavioral/Physical Health Form, Outpatient Treatment Request forms, and more. m. If you are experiencing technical difficulties with submitting an electronic prior authorization, call to submit a verbal prior authorization. Refer to the Medical Pharmacy Prior Authorization Lists and Utilization Management program details in the Manual for Physicians and Providers. Prior Authorization;. Learn more today.
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During regular business hours, your call will be answered by our Utilization Management department. Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect Prior authorization (cont. .
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You can obtain a copy of a specific policy by calling the clinical services department at 1-888-234-2393. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be. Select the to access up-to-date coverage information in your drug list, including – details about brands and generics, dosage/strength options, and information about prior authorization of your drug. Submitting a prior authorization request and clinical: •Providers may request prior authorization and submit clinical through the Interactive Care Reviewer (ICR) portal. CPT® code 95800 (sleep study, unattended, simultaneous recording of heart rate, oxygen saturation, respiratory airflow, and respiratory) will require prior authorization (PA).
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All home health and hospice services 800-782-4437. . Sep 14, 2021 · Prior Authorization & Claims overview; Claims Submissions and Disputes; Electronic Data Interchange; Prior Authorization Requirements. .
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• Prior Authorization Lookup Tool (PLUTO): https://mediproviders. When required, beginning April 1, 2021, color dose volume histograms must be in color.
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Visit the Independence Blue Cross medical policy page for more information. – 9 p.
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If you have questions regarding your PA request, call us at 1-844-533-1995 for members enrolled in Healthy Indiana. View the status of an authorization by visiting the clinician portal; By Fax. The tool guides you through all of the forms you need so you. A library of the forms most frequently used by health care professionals.
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. Prior authorization for these drugs should continue to be obtained from Florida Blue or MagellanRx Management. Send all listed documentation with the SUD PA form.
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• Pharmacy prior authorizations: Call Provider Services lines Hoosier Healthwise —1-866-408-6132 Hoosier Care Connect —1-844-284-1798 Healthy Indiana Plan —1-844-533-1995 Providers can submit prior authorization requests for any prescription drugs that require prior authorization to Anthem. .
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Under the fee-for-service (FFS) delivery system, decisions to authorize, modify or deny requests for PA are based on medical.
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Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect Prior authorization (cont. •Providers may call Anthem to request prior authorization for inpatient health services using the following phone numbers: Hoosier Healthwise: 866-408-6132 Healthy Indiana. . . Provider Authorization [590 Program membership information for outside the 590 Program facility] – State Form 15899 (R5/10-18)/OMPP.
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Medicaid only (BCCHP and MMAI) Medicaid Service Authorization Dispute Resolution Request Form. . At Anthem Blue Cross and Blue Shield (Anthem), we value you as a provider in our network. m.
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. The Sydney Health app makes it easy to find a doctor, access your ID card, chat with a live representative, and more.
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. PA requests may be submitted to Gainwell online via the IHCP Provider Healthcare Portal; by mail or fax, using the appropriate PA request form; or (in some cases) by telephone at 800-457-4584, option 7. m.
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Send all listed documentation with the SUD PA form. April 2017.
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Use black or blue ink to ensure the scanner can read the claim. *GHI PPO City of New York employees and non-Medicare eligible retirees with GHI PPO benefits will be managed by Empire BCBS for inpatient and outpatient. .
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Indiana Health Coverage Programs. Agreement Between 590 Facilities and the OMPP. Step 4: Within the tool, select Send Attachment then Predetermination Attachment.
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1-844-284-1798. Quick Reference Guide (PDF) - last updated Feb 2, 2022. • Pharmacy prior authorizations: Call Provider Services lines Hoosier Healthwise —1-866-408-6132 Hoosier Care Connect —1-844-284-1798 Healthy Indiana Plan —1-844-533-1995 Providers can submit prior authorization requests for any prescription drugs that require prior authorization to Anthem.
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Fee-for-Service Gainwell Technologies P: 800-457-4584, option 7 F: 800-689-2759 Hoosier Healthwise MDwise Hoosier Healthwise. Title. .
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Medicare $0. On this page you can easily find and download forms and guides with the information you need to support both patients and your staff. For questions or issues with the CenterX, please reach out to your EMR vendor. org.
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You can obtain a copy of a specific policy by calling the clinical services department at 1-888-234-2393. Quick Reference Guide (PDF) - last updated Feb 2, 2022. elegant.
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1-800-331-6221. ET Monday – Friday and Saturday from 10 a. . CoverMyMeds automates the prior authorization (PA) process making it a faster and easier way to review, complete and track PA requests.
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Jan 11, 2021 · New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. Oct 11, 2021 · Retail Pharmacy Prior Authorization Forms; Medical Injectable Prior Authorization Form; Synagis Prior Authorization Form; Submit prior authorizations online with Interactive Care Review; Behavioral Health outpatient authorization process; Home Health wound care update; Indiana Medicaid Prior Authorization Requirements List.
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. Appeal/Disputes. Form Title Network(s) Refer to the Pharmacy Program section for more information. Sep 9, 2022 · Access behavioral health forms for providers at MHS Indiana like the Behavioral/Physical Health Form, Outpatient Treatment Request forms, and more.
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Use the correct form and be sure the form meets Centers for Medicare & Medicaid Services standards. .
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. About prior authorization. . Members can log in to view forms that are specific to their plan. Visit the Independence Blue Cross medical policy page for more information.
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Step 2: Select Claims & Payments from the navigation menu. to 8 p.
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0, August 2022 Page 1 of 1. Indiana state specific prior authorization request form. Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit.
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. . Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit.
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Forms and Guides; Policies, Guidelines & Manuals; Provider Maintenance; Pharmacy; Behavioral Health; Dental; Vaccination Resources; Find Care; Availity; Claims Claims. . Select the to access up-to-date coverage information in your drug list, including – details about brands and generics, dosage/strength options, and information about prior authorization of your drug. m.