{"id":327,"date":"2022-07-01T19:19:09","date_gmt":"2022-07-01T19:19:09","guid":{"rendered":"https:\/\/ppmco.foxtrotdev.com\/?page_id=327"},"modified":"2023-03-21T15:05:26","modified_gmt":"2023-03-21T15:05:26","slug":"important-forms","status":"publish","type":"page","link":"https:\/\/ppmco.foxtrotdev.com\/?page_id=327","title":{"rendered":"Important Forms"},"content":{"rendered":"<div id=\"block_39f1062165191dd62aa9364d5963e628\" class=\"wpfox-page-header standard has-cta\" style=\"--fgimage-xpos: 130;\">\r\n\t<div class=\"wrapper banner\">\r\n\t\t<div class=\"bg-glow\"><\/div>\r\n\t\t\t\t<div class=\"text-block\">\r\n\t\t\t\n\n<h1 class=\"page-title has-h-3-font-size wp-block-heading\">Member Forms<\/h1>\n\n\n\n<h2 class=\"has-h-1-font-size wp-block-heading\">Find and download the forms you need<\/h2>\n\n\r\n\t\t<\/div>\r\n\t\t<div class='fgimage'><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"990\" src=\"https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/fg-forms.png\" class=\"attachment-large size-large\" alt=\"Adult woman wearing yellow sweater smiling\" srcset=\"https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/fg-forms.png 600w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/fg-forms-182x300.png 182w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><\/div>\t<\/div>\r\n\t\n\t\t<div class='cta-bar page-header-jumpmenu'>\n\t\t\t<form class='desktop'>\n\t\t\t\t<label>Find care now:<\/label>\n\t\t\t\t<div class='prepend'>I need<\/div>\n\t\t\t\t<select class='jumpmenu'>\n\t\t\t\t\t<option value='https:\/\/pp.healthtrioconnect.com\/public-app\/consumer\/provdir\/entry.page' data-target='_blank'>a doctor<\/option><option value='https:\/\/www.caremark.com\/' data-target='_blank'>a pharmacy<\/option><option value='https:\/\/ppmco.foxtrotdev.com\/plan-benefits\/dental-care\/' data-target=''>a dentist<\/option><option value='https:\/\/superiorvision.com\/members\/' data-target='_blank'>vision care<\/option><option value='https:\/\/pp.healthtrioconnect.com\/public-app\/consumer\/provdir\/search.page?lat=&#038;long=&#038;searchString=&#038;sortType=NAMEASC&#038;provType=H&#038;addressState=md&#038;providerSpecialty=hospital&#038;myAddress=&#038;myCity=&#038;myState=md&#038;myZip=&#038;distance=25&#038;ageId=&#038;sexId=&#038;conditionId=&#038;xsesschk=undefined' data-target='_blank'>a hospital<\/option>\n\t\t\t\t<\/select>\n\t\t\t\t<a class='btn'>Go<\/a>\n\t\t\t<\/form>\n\t\t\t<div class='mobile'>\n\t\t\t\t<label>Find care now<\/label>\n\t\t\t\t<a class='btn' href='https:\/\/ppmco.foxtrotdev.com\/find-care-now\/' target=''>Go<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\n<div class=\"wp-block-group is-style-section-padding is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"has-text-align-center has-purple-color has-text-color wp-block-heading\">Important Forms for Our Members<\/h2>\n\n\n\n<p class=\"has-text-align-center has-intro-font-size wp-block-paragraph\">Priority Partners provides immediate access to required forms and documents to assist our <br>providers in expediting claims processing, prior authorizations, referrals, credentialing and more. <br><strong>Here are some forms you may need to help you manage your health coverage.<\/strong><\/p>\n\n\n<div id=\"block_c40c60b5d042bcd0a3fbbda182639078\" class=\"wpfox-important-forms\">\r\n    <div class=\"wp-container wp-block-group\">\r\n\t\t<div class=\"forms-filters\">\r\n\t\t\t<form>\r\n\t\t\t\t<div class=\"wp-block-search__inside-wrapper \">\r\n\t\t\t\t\t<input type=\"search\" class=\"wp-block-search__input \" name=\"s\" value=\"\" placeholder=\"Search Forms\" required=\"\">\r\n\t\t\t\t\t<button type=\"submit\" class=\"wp-block-search__button\">Search<\/button>\r\n\t\t\t\t<\/div>\r\n\t\t\t<\/form>\r\n\t\t<\/div>\r\n\t\t<div class=\"forms\">\r\n\t\t\t\r\n\t\t\t<div class='form'>\r\n\t\t\t\t<h3 class='title has-h-4-featured-font-size'><a href='https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/08\/authorization-for-release-of-health-information-standing.pdf' target='_blank'>Authorization for Release of Health Information \u2013 Standing<\/a><\/h3>\r\n\t\t\t\t<div class='description'><!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">This form lets you choose someone you trust to have access to your health records. You can also decide how much of your personal health information you want that person to know. Do not worry, if you do not fill out this form, Priority Partners will continue to keep your health information protected and private.<\/p>\n<!-- \/wp:paragraph --><\/div>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\t<div class='form'>\r\n\t\t\t\t<h3 class='title has-h-4-featured-font-size'><a href='https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/08\/authorization-for-release-of-health-information-specific-request.pdf' target='_blank'>Authorization for Release of Health Information \u2013 Specific Request<\/a><\/h3>\r\n\t\t\t\t<div class='description'><!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Like the \u201cstanding\u201d version of this form, you can choose someone you trust to have \u201cone-time\u201d access to a specific part of your personal health information. Do not worry, if you do not fill out this form, Priority Partners will continue to keep your health information protected and private.<\/p>\n<!-- \/wp:paragraph --><\/div>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\t<div class='form'>\r\n\t\t\t\t<h3 class='title has-h-4-featured-font-size'><a href='https:\/\/www.hopkinsmedicine.org\/-\/media\/johns-hopkins-health-plans\/documents\/ppmco\/pp-compound-prior-authorization-form.pdf' target='_blank'>Pharmacy Compound Drug Prior Authorization Form<\/a><\/h3>\r\n\t\t\t\t<div class='description'><!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">If your doctor is not able to substitute an ingredient in a medication or prescribe a different drug to you, they will need to fill out this form to request prior authorization for a compound drug.<\/p>\n<!-- \/wp:paragraph --><\/div>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\t<div class='form'>\r\n\t\t\t\t<h3 class='title has-h-4-featured-font-size'><a href='https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/08\/paperclaim_std_eng.pdf' target='_blank'>Pharmacy Prescription Reimbursement Standard Claim Form<\/a><\/h3>\r\n\t\t\t\t<div class='description'><!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">If you previously paid for prescriptions without using your Priority Partners insurance, you can fill out this form to start the reimbursement process. Note: Your request will be reviewed, and reimbursement is not guaranteed.<\/p>\n<!-- \/wp:paragraph --><\/div>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\t<div class='form'>\r\n\t\t\t\t<h3 class='title has-h-4-featured-font-size'><a href='https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/08\/Secondary_Claim.pdf' target='_blank'>Pharmacy Prescription Reimbursement Secondary Claim Form<\/a><\/h3>\r\n\t\t\t\t<div class='description'><!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">This form should be used ONLY if you are submitting claims for secondary prescription coverage. Note: Your request will be reviewed, and reimbursement is not guaranteed.<\/p>\n<!-- \/wp:paragraph --><\/div>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\t<div class='form'>\r\n\t\t\t\t<h3 class='title has-h-4-featured-font-size'><a href='https:\/\/www.hopkinsmedicine.org\/-\/media\/johns-hopkins-health-plans\/documents\/ppmco\/pp_prior_authorization_form.pdf' target='_blank'>Pharmacy Prior Authorization Form<\/a><\/h3>\r\n\t\t\t\t<div class='description'><!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">Drugs that are not listed in the formulary must be approved by your doctor before they can be filled at the pharmacy. In order for your doctor to request that Priority Partners cover a medication for you, print this form and take to your PCP to fill out and submit.<\/p>\n<!-- \/wp:paragraph --><\/div>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\t<div class='form'>\r\n\t\t\t\t<h3 class='title has-h-4-featured-font-size'><a href='https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/08\/representation-legal-responsibility-minor.pdf' target='_blank'>Representation of Responsibility for Minor Child<\/a><\/h3>\r\n\t\t\t\t<div class='description'><!-- wp:paragraph {\"className\":\"is-style-default\"} -->\n<p class=\"is-style-default\">If you are over 18 years old, filling out this form will give you the right to represent and make health care information-related decisions about a minor child who is 17 years old or younger. The adult representative can only be the minor\u2019s parent, stepparent, legal guardian or kinship caregiver.<\/p>\n<!-- \/wp:paragraph --><\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\t\t<div class='no-results'>No results found. Please try a new search.<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div><\/div>\n\n\n<div id=\"block_278685caa358af24c0e8aed8d07bb98d\" class=\"wpfox-text-image-section default-padding circle\">\r\n\t<div class=\"wrapper has-teal-background-color\">\r\n\t\t<div class=\"row row-text-image image-right\">\r\n\t\t\t<div class=\"col col-text\">\r\n\t\t\t\t\n\n<h4 class=\"has-h-4-featured-font-size wp-block-heading\">Member Resources<\/h4>\n\n\n\n<h2 class=\"has-h-2-featured-font-size wp-block-heading\">Paper Versions of All Member Forms Can Be Mailed to You.<\/h2>\n\n\n\n<p class=\"is-style-default has-intro-font-size wp-block-paragraph\">All documents are available in <strong>paper form without charge<\/strong>. To request a paper copy, please call <strong>Customer Service<\/strong> at:<\/p>\n\n\n\n<div class=\"wp-block-buttons is-style-margin-top-10 is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-phone-icon-no-tab\"><a class=\"wp-block-button__link has-white-color has-gold-background-color has-text-color has-background wp-element-button\" href=\"tel:800-654-9728\">800-654-9728<\/a><\/div>\n<\/div>\n\n\n\n<p class=\"is-style-default margin-top-0 wp-block-paragraph\">Monday through Friday, 8 a.m. to 5 p.m.<\/p>\n\n\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"col col-image\">\r\n\t\t\t\t\r\n\t\t\r\n\t\t\t<div class='image-wrapper'>\r\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-1024x1024.jpg\" class=\"attachment-large size-large\" alt=\"Woman waving during a video call\" srcset=\"https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-1024x1024.jpg 1024w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-300x300.jpg 300w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-150x150.jpg 150w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-768x768.jpg 768w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-1536x1536.jpg 1536w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help.jpg 1920w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\r\n\t\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Important Forms for Our Members Priority Partners provides immediate access to required forms and documents to assist our providers in&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":28,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"13456,11564,11561,11554,11521,10868","_relevanssi_noindex_reason":"","inline_featured_image":false,"footnotes":""},"class_list":["post-327","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - 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