Maryland PPHP Provider Documents – Provider Partners Health Plan

Provider Information

Medical Information and Authorization

Authorization Form

H8067_C_DOCUMENTSWEB CMS Pending

Pharmacy Information and Authorization

Formulary 2019

2019 Comprehensive Formulary (Prescription Drugs)
(Last Updated 2/2019)
2019 Formulary (Prescription Drugs) Changes
(Last Updated 2/2019)
2019 Prior Authorization Criteria
(Last Updated 2/2019)
2019 Step Therapy Criteria
(Last Updated 2/2019)
2019 Quantity Limits
(Last Updated 2/2019)
2019 Formulary (Prescription Drugs) Search Tool
Online Part D Coverage Determination/Redetermination

Member Benefit Information

2019 Summary of Benefits
(contains multi-language insert)

Provider Partners Illinois Advantage offered by Provider Partners Health Plan is a health plan with a Medicare Contract. Enrollment in Provider Partners Illinois Advantage depends on contract renewal.
H8067_002_PPHPWEB CMS Pending

Provider Partners Maryland Advantage offered by Provider Partners Health Plan is a health plan with a Medicare Contract. Enrollment in Provider Partners Maryland Advantage 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 Health Plan of Ohio depends on contract renewal.
H7119_001_PPHPWEB CMS Pending

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

Last updated 2/1/2019

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