ATRIO Health Plans
338 Jericho Turnpike #135
Syosset, NY 11791
Please continue to send REFUND CHECKS to:
ATRIO Health Plans
2965 Ryan Drive SE
Salem, OR 97301
The PPO Formulary is a tiered formulary that consists of 6 tiers
Tier 1 – Preferred Generic Drugs - lowest cost generic drugs
Tier 2 – Generic Drugs - may include few preferred brand
Tier 3 – Preferred Brand Drugs - may include high-cost generic drugs
Tier 4 – Non-Preferred Brand Drugs - non-preferred brand or generic, non-formulary drugs
Tier 5 – Specialty Drugs - highest cost-sharing tier
Tier 6 – Select Care Drugs (Zero-copay)
Inflation Reduction Act
Beneficiaries pay less for some drugs covered under Medicare Part B and nearly all Part D covered drugs, if the drug cost increases faster than the US inflation rate (Part B 20% coinsurance is based on the lower-adjusted price)
Beneficiaries may not pay more than $35 for a 30-day supply of Part D insulin products even if they have not met their deductible(s) or have entered the Part D Coverage Gap. Effective July 1, 2023, insulin covered by Part B (applicable when administered using an insulin pump) also may not cost more than $35 for a 30-day supply
NOTE : Between January 1st and January 18th, 2023, ATRIO members may have been charged more than $35 for Part D insulin if they were in the Coverage Gap or if they received a non-formulary insulin product (e.g., Lantus) during a transition fill(s)
1. What should members do?
Members can call ATRIO Customer Service at 1-877-672-8620 (TTY: 711) and request reimbursement
2. What can prescribers do?
Switch your ATRIO members to a formulary insulin, if clinically appropriate
Beneficiaries must not have cost-sharing for all vaccines recommended for adults by the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP), such as the shingles vaccine; this change brings Part D vaccine coverage more in line with Part B for other approved vaccines (including the flu and COVID-19)
NOTE : Following the end of the US Public Health Emergency (PHE) on May 11, 2023, cost-sharing may begin to apply for approved Part B COVID treatments
View ATRIO’s Star Ratings Program page for measure descriptions and resource materials.
For questions on the Star Ratings Program, please click here to contact ATRIO Quality Improvement.
Opioid drugs (“opioids”) have serious risks such as addiction, overdose, and death. CMS is very concerned about the opioid epidemic and its effect on our communities, and is committed to a complete strategy to combat this public health emergency. Several drug management programs are in place to prevent and combat opioid overuse.
Click here to see the formulary-level opioid safety edits at the point of sale, as recommended by CMS.
VSP Provider Customer Service Line:
1.800.615.1883 Monday – Saturday: 6:00 a.m. – 5:00 p.m. PST
Additional helpful provider information can be found at the following link:
To learn more about becoming an in network VSP provider please see link below:
To see extra benefits ATRIO offers, please select the link below:
Provider Appeal Form - Electronic Submission
Provider Appeal Form - Fillable PDF
An Appeal may be filed for any of the following reasons:
Who Can Appeal?
An Appeal may be filed by the following:
Part D Appeal
Appeal of adverse decision regarding a Part D medication -- Prescriber - MD, DO, NP, PA can file over the phone, in writing or by fax
Part C Pre-Service Appeal
Appeal of an adverse decision for pre-authorization of a service -- Physician - can file over the phone, in writing or by fax
Part C Payment Appeal
Appeal of an adverse decision of a claim must be received in writing
Providers can use the forms above, otherwise request for Appeal need to include the following:
Must be submitted in writing using forms below
Provider Claim Dispute Form - Electronic Submission
Provider Claim Dispute Form - Downloadable PDF (Print and Fax)
Payment Dispute – Providers disputing the manner in which a claim was paid
Par Provider Reconsideration – Dispute of a claim or claim line denial
Last updated Oct 20, 2023