For Providers
Prior Authorization Forms
View a complete listing of our 2009 prior authorization
forms.
View a complete listing of our 2010 prior authorization
forms.
Payer Sheets
View critical items (PDF) from our payer sheets.Coverage Determination Request Form
Print out a coverage determination/medical exception form (PDF).
Best Available Evidence (BAE)
Federal regulations at 42 CFR § 423.800 specify the requirements of Part D sponsors in the administration of the low-income subsidy program, including the reduction of cost sharing for subsidy-eligible individuals. In certain cases, CMS systems do not reflect a beneficiary's correct low-income subsidy (LIS) status at a particular point in time. As a result, the most up-to-date and accurate subsidy information has not been communicated to the Part D plan.
To address these situations, CMS created the best available evidence (BAE) policy in 2006. This policy requires sponsors to establish the appropriate cost-sharing for low-income beneficiaries when presented with evidence that the beneficiary's information is not accurate.
Please to go to the CMS Website and look through the downloads area for materials related to the CMS BAE policy.
