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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Elixir c/o American Health Advantage of Idaho (HMO ISNP) ATTN: Appeals Department 7835 Freedom Avenue NW North Canton, OH 44720Fax Number: 8775037231You may also ask us for a coverage determination by phone at 8336746196 or through our website at id.amhealthplans.com Who May Make a Request: Your prescriber may ask us for a coverage determination on your behalf. If you want another
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Obtain the Elixir Co American Health application form from their website or an authorized representative.
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Elixir Co American Health is a health management and pharmacy benefit company that provides prescription drug plans and health services to individuals and organizations.
Typically, employers who provide health benefits to their employees or organizations that offer health insurance plans may be required to file forms related to Elixir Co American Health.
To fill out Elixir Co American Health forms, gather necessary personal and insurance information, follow the instructions on the form carefully, and ensure all required sections are completed accurately.
The purpose of Elixir Co American Health is to manage prescription drug benefits, help improve health outcomes, and provide cost-effective solutions for medication management.
Information required includes personal identification details, insurance policy numbers, prescription details, and any relevant health information as specified in the filing forms.
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