MANDATORY CMS GUIDANCE:
All PDP/Drug and all MA/MAPD applications must be “submitted directly” from the writing agent’s office within “24 hours” of app signature date to the respective home office.
Application Fax Cover Sheets & Phone Numbers
Aetna MA-MAPD & PDP Enrollment Options
- Fax Cover Sheet
- Fax Confirmation & App Status Phone Number: 1-866-714-9301
AmeriHealth NJ PAPER MA-MAPD & PDP Fax Cover Sheet
AmeriHealth NJ ONLINE MA-MAPD & PDP Fax Cover Sheet
- Fax Confirmation & App Status Phone Number: 1-888-234-3313
Coventry/Health America MA-MAPD Fax Cover Sheet
- Fax Confirmation & App Status Phone Number: 1-866-714-9301
- Fax Confirmation & App Status Phone Number: 1-855-841-2498
First Health PDP Fax Cover Sheet
- Fax Confirmation & App Status Phone Number: 1-866-714-9301
Humana MA-MAPD & PDP Fax Cover Sheet
- Fax Confirmation & App Status Phone Number: 1-800-309-3163
- MAPA Online Enrollment Instructions
Independence Blue Cross PA PAPER MA-MAPD & PDP Fax Cover Sheet
Independence Blue Cross PA ONLINE MA-MAPD & PDP Fax Cover Sheet
- Fax Confirmation & App Status Phone Number: 1-888-234-3313
SilverScript Enrollment Instructions
- SilverScript Online Enrollment User Guide
- Fax Confirmation & App Status Phone Number: 1-888-277-4174
United Healthcare MA-MAPD & PDP Fax Cover Sheet
- Fax Confirmation & App Status Phone Number: 1-888-381-8581
Universal American/Today’s Options MA-MAPD Fax Cover Sheet
- Fax Confirmation & App Status Phone Number: 1-800-332-3377
- EASE Online Enrollment Instructions