Provider Information

Medical Information and Authorization

  • Authorization Form
iStock-599996108-web

H7119001_C_DOCUMENTSWEB CMS Pending

Pharmacy Information and Authorization

Formulary 2019

Member Benefit Information

Provider Partners Health Plan of Illinois is a Health Plan with a Medicare Contract. Enrollment in Provider Partners of Illinois Health Plan depends on contract renewal.
H8067_002_PPHPWEB CMS Pending

Provider Partners Health Plan of Maryland is a Health Plan with a Medicare Contract. Enrollment in Provider Partners of Maryland Health Plan depends on contract renewal.
H8067_001_PPHPWEB CMS Pending

Provider Partners Health Plan of Ohio is a Health Plan with a Medicare Contract. Enrollment in Provider Partners of Ohio Health Plan depends on contract renewal.
H7119_001_PPHPWEB CMS Pending

Provider Partners Health Plan of Pennsylvania is a Health Plan with a Medicare Contract. Enrollment in Provider Partners of Pennsylvania Health Plan depends on contract renewal.
H4093_001_PPHPWEB CMS Pending

Last updated 11/01/2018

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