Transcription of Clover Quick Reference Guide
1 CloverQuick Reference GuideFREQUENTLY USED SERVICESQUICK LINKSTo request a pre-authorization, check the status of an existing request, or view a list of required servicesPre-Authorization Lookup ToolTo view pharmacy pre-authorization criteriaWe typically respond to completed forms within 24 business web: Pre-Authorization Requestvia print/fax: Pre-Authorization Request FormTo submit a claim If you need to make any changes to an original claim you can resubmit a corrected claim using the above via Change Healthcare:Payer ID#: 77023via mail: Clover Box 3236 Scranton, PA 18505To find an in-network providerProvider DirectoryTo view pre-authorization criteriaFormularyTo dispute a paymentPayment Dispute Formvia fax:1-732-412-9706via mail: Attn.
2 Appeals and Grievances Clover Box 471 Jersey City, NJ 07303To appeal a pre-service denialClover Appeal FormTo appeal a Part D denialRequest for Redetermination of Medicare Prescription Drug Denial FormFor routine issues or operational itemsClover Provider Tools PageDEPARTMENTPHONEFA XProvider Services1-877 -853 - 8019 Care Management1-888 -995 - 1689 Authorization Requests (UM) 1-888 -995 -16901-800-308-1107 Pharmacy (CVS/Caremark) 1-855 -294-5979 Appeals & Grievances1-877 -853 - 80191-732-412-9706 Member Services1-888 -657 - 1207
