Information for Healthcare Providers and Pharmacies

Welcome

Thank you for visiting Today's Options^® PPO . This site provides you helpful resources that Today’s Options PPO providers 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^® PPO plans.

The Provider Portal

The Today’s Options PPO Provider Portal enables 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 and validate Authorizations

Additional Provider Resources

• 2011 Today's Options PPO Provider Manual (PDF)
• 2012 Today's Options PPO Provider Manual (PDF)
• Provider Quick Reference Sheet (PDF)
• EDI Flyer (PDF)
• 5010 Provider Billing Update (PDF)
• Provider Payment Dispute Resolution Form (PDF)
• Provider Payment Dispute Resolution Instructions for Non-Contracting Providers
• 2012 Today's Options PPO Referral/Auth. Request Form (PDF)
• 2012 Today’s Options PPO Authorization Guidelines (By Service Area):
  • New York
  • Arkansas and Pennsylvania
  • Mississippi, Missouri, North Carolina and Wisconsin
  • Georgia, Indiana, Maine, Montana, Oklahoma, South Carolina, Texas and Virginia
  • Nebraska
• 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^® PPO plans.

  • Formulary and Prior Authorization 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^® PPO plans.

  • Medicare Part D Prescription Claim Form (PDF)
• Advanced and Cardiology Imaging (applicable in select PPO markets):
  • Ordering a Cardiac PET Procedure Form (PDF)
  • Ordering Cardiac MRI Procedures Form (PDF)
  • Ordering Coronary CT Angiography and Cardiac CT Procedures (PDF)
  • Ordering Myocardial Perfusion Imaging or Stress Echocardiogram Studies (PDF)
  • Ordering Outpatient Diagnostic Left Heart Catheterization Procedures (PDF)
  • Ordering Transthoracic Echocardiography Procedures (PDF)
  • Provider Frequently Asked Questions (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)