CAUTION: Please be sure to select the correct fax number on the Authorization Form for your county/service area. Use of an incorrect fax number may cause unnecessary delays in getting your authorization request to the appropriate medical review team.
Please remember that patient confidentiality and privacy is protected under HIPAA, so using the correct form and fax number will ensure to protect you against inappropriate disclosures.
OR you may submit an: ATRIO Medimpact Medicare Part D Coverage Determination Request Form
Click below to watch a tutorial for more information on using CoverMyMeds, including:
Last updated Nov 03, 2023