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Provider Resources
Medicare Parts C and D General Compliance Training
Combating Medicare Parts C and D Fraud,Waste, and Abuse Training
Compliance Program
Non-Contracted Provider Payment Appeals and Claim Disputes
List of Services that require Prior Authorization
Medical Care, Services, and Payment
Accounting Request Form
PTHP General Compliance Disciplinary Standards
PTHP Confidential Methods of Reporting Compliance FWA
Part D Provider
Documents
Criteria – Prior Authorization Aultimate, Plus, and Classic Plans
Criteria - Step Therapy Aultimate, Plus, and Classic Plans
2020 Tier 1 Medications
2021 Tier 1 Medications
Medicare Part D Coverage Determination Form (for use by Enrollees and Providers)
Policies &
Procedures
PrimeTime Code of Business Conduct and Ethics
Credentialing Forms
Provider update information form
Pre- Authorization & Referral Forms
PrimeTime Health Plan Pre-authorization and Referral Form
PrimeTime Health Plan Home Health Care Services Form
Molecular Diagnostic Request
Last updated: 08/25/2020