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Direct Complete Plan
H5989 Provider Documents
Annual Notice of Change
(ANOC)
Formulary
Low Income Subsidy (LIS) Premium Table
Multi-Language Interpreter Services
Medicare Plan Ratings
Appeal/Redetermination Request Form
Prior Authorization Criteria
Step Therapy Criteria
H5989 Provider Portals
Thank You for being a Provider of Health Pointe Direct Complete Plan
(HMO I-SNP)
Coverage Decisions
If a drug is not covered in the way you would like it to be covered, you can ask us to make an exception or coverage decision to our coverage rules. Similar to other types of coverage decisions, if we turn down your request for an exception, you can appeal our decision. When you ask for an exception, please explain the medical reasons why you need the exception approved for consideration. More information can be found on the Medicare Part D (Pharmacy) Information page or the Evidence of Coverage (PDF).
You can use one of the following methods to request a formulary exception:
Submit Electronically
Making an Appeal/Redeterminations
If we make a coverage decision and you are not satisfied with this decision, you can appeal the decision or ask for a redetermination. You must make your appeal request within 60 calendar days from the date on the coverage decision written notice we sent. More information can be found on the Medicare Part D (Pharmacy) Information page or the Evidence of Coverage (PDF).
You can use one of the following methods to request an appeal:
Submit Electronically
Health Pointe Direct Complete Plan (HMO I-SNP) is a Health Plan with a Medicare Contract. Enrollment in Health Pointe HMO I-SNP depends on contract renewal.
CMS Material ID: H5989_HPweb2019 | Last updated 12/10/2019