Documents & Forms Center

Members

QI Commercial Program Description 2021

PDF icon PD-QI-Commercial-2021.pdf

Members

QI Commercial Program Description 2022

PDF icon PD-QI-Commercial-2022.pdf

Members

QI Medicare Program Description 2021

PDF icon PD-QI-Medicare-2021.pdf

Members

QI Medicare Program Description 2022

PDF icon PD-QI-Medicare-2022.pdf

Quality Choice 15.50.100 1-1-22

PDF icon Quality Choice 15.50.100 1-1-22.pdf

Quality Choice 15.50.100 1-1-22 25%

PDF icon Quality Choice 15.50.100 1-1-22 25%.pdf

Quality Choice 15.50.100 1-1-23

PDF icon Quality-Choice-15.50.100-1-1-23.pdf

Quality Choice 15.50.100 1-1-23 25%

PDF icon Quality-Choice-15.50.100-1-1-23-25percent.pdf

Quality Choice 15.50.100 10-01-21

PDF icon quality-choice-15.50.100-10-01-21.pdf

Agents, Employers

Quality Choice 15.50.100 10-1-19

PDF icon Quality Choice 15.50.100 10.01.19.pdf

Agents, Employers

Quality Choice 15.50.100 10-1-19 25%

PDF icon Quality Choice 15.50.100.25 10-01-19.pdf

Agents, Employers

Quality Choice Exclusive 6 Tier Rx $750 10-1-19

PDF icon Quality Choice Exclusive 6 Tier Rx 750 10-01-19.pdf

Agents, Employers

Quality Choice Exclusive 6 Tier Rx 10-1-19

PDF icon Quality Choice Exclusive 6 Tier Rx 10-01-19.pdf

Members

Quality Improvement Behavioral Health Program Description

PDF icon PD-BH-QI-2022.pdf

Members

Quality Improvement COM Program Description

PDF icon PD-QI-Commercial-20221.pdf

Quality Improvement MCR Program Description

PDF icon PD-QI-Medicare-2022.pdf

Members

Quality Improvement Program Evaluation

PDF icon 2019 QI Program Evaluation.pdf

Medicare

Request for Medicare Prescription Drug Coverage Determination Form

PDF icon 2021 Request for Prescription Drug Coverage Determination.pdf

Providers

Residential Eating Disorders Treatment Com

PDF icon Residential-Eating-Disorders-Treatment-COMM.pdf

Providers

Residential Substance Abuse Treatment Com

PDF icon Residential-Substance-Abuse-Treatment-COMM.pdf

Medicare

Safe Use of Opioid Pain Medication – Information for Medicare Part D Patients

PDF icon cms_partd_opioid_beneficiary_tip_sheet_20181206_508.pdf

Agents, Employers

Sales and Acct Mgmt FAQs for web

PDF icon Sales and Acct Mgmt FAQs for web.pdf

Secondary Prevention for Patients with Atherosclerotic Vascular Disease

PDF icon Secondary Prevention for Patients with Atherosclerotic Vascular Disease.pdf

Providers

Skilled Nursing Facilities Com

PDF icon Skilled-Nursing-Facilities-COMM.pdf