Information for Healthcare Providers and Pharmacies

Welcome

Thank you for visiting Today's Options^® PFFS. This site provides you helpful resources you need to better understand your patient's coverage. Learn about the pharmacy benefits for your patient’s prescription drug coverage. Please note: by clicking on this link you will be redirected to the MemberHealth, LLC website. MemberHealth, LLC is part of the CVS Caremark family of companies. CVS Caremark Part D Services is the Pharmacy Benefits Manager (PBM) for Today's Options^® PFFS plans.

The Provider Portal

The Provider Portal will enable providers to conduct a wide range of self-service transactions and inquiries in a secure online environment. These services include eligibility inquiry, benefit summaries, claim status, and validation of referrals and authorizations.

Services available on the Provider Portal are:

• Provider level demographic detail
• Member Eligibility detail
• Benefit Summary for eligible members
• Claims detail
• Submit/Validate Authorizations

Terms and Conditions

The Terms and Conditions (PDF) for Today's Options PFFS are important information for physicians who accept or are considering accepting members of our plan. The Terms and Conditions include:

• Rate and billing information
• Plan availability
• Important information for your patients
• Rights and responsibilities of Providers

Additional Provider Resources

• 2011 Today's Options PFFS Provider Manual (PDF)
• 2012 Today's Options PFFS Provider Manual (PDF)
• Provider Quick Reference Sheet (PDF)
• EDI Flyer (PDF)
• 2012 Today's Options PFFS Proxy Grid (PDF)
• 5010 Provider Billing Update (PDF)
• Provider Payment Dispute Resolution Form (PDF)
• Provider Payment Dispute Resolution Instructions for Non-Contracting Providers
• 2012 Advanced Determination Request Form
• Medicare Part D Resources:
  • Formulary Changes and Updates
  • Pharmacy Prior Authorization Status Search

    Please note: by clicking on this link you will be redirected to the MemberHealth, LLC website. MemberHealth, LLC is part of the CVS Caremark family of companies. CVS Caremark Part D Services is the Pharmacy Benefits Manager (PBM) for Today's Options^® PFFS plans.

  • Authorizations and Exceptions Forms

    Please note: by clicking on this link you will be redirected to the MemberHealth, LLC website. MemberHealth, LLC is part of the CVS Caremark family of companies. CVS Caremark Part D Services is the Pharmacy Benefits Manager (PBM) for Today's Options^® PFFS plans.

  • Medicare Part D Prescription Claim Form (PDF)

Medicare Fraud, Waste and Abuse Training

Please view Universal American’s Fraud, Waste and Abuse Training for Healthcare Professionals (PDF) and the following Fraud, Waste and Abuse Training Fact Sheets for:

• Pharmacies (PDF)
• Providers (PDF)
• Entities That Support Medicare Activities (PDF)

Sample 2012 Member ID Cards

• Medicare Advantage (MA) - Sample Member ID Card (PDF)
• Medicare Advantage Prescription Drug (MA-PD) - Sample Member ID Card (PDF)