Authorization Requests

To request an authorization (coverage determination) for medical services, contact your patient’s Interdisciplinary Team (IDT) or call our Utilization Management department at 1-855-769-2508.

Your may fax a prior authorization request form and clinical documentation to our Utilization Management department at 1-855-769-2509.

Mail us an authorization request for medical services at:

PHP Care Complete FIDA-IDD Plan
Utilization Management
6303 Commerce Drive, Suite 180
Irving, TX 75063

To request a coverage determination for any prescription drugs, you should submit a Medicare Prescription Drug Coverage Determination request form for your patient.

Fax your request to us:

For standard coverage determinations: 1-855-839-3876

For Urgent (expedited) coverage determinations: 1-855-839-3877

Mail your coverage determination to us at:

PHP Care Complete
Rx Redetermination
200 Stevens Drive
Philadelphia, PA 19113


Appeals

To file an appeal for medical services, you can:

Call our appeals department at 1-855-769-2508; OR

Fax your appeal to us.  Our fax number is 1-855-769-2509; OR

Write your appeal and mail it to us at:

PHP Care Complete FIDA-IDD Plan
Appeals Department
6303 Commerce Drive, Suite 180
Irving, TX 75063

To file an appeal related to prescription drugs, you can submit a Request for Redetermination of Medicare Prescription Drug Denial on behalf of your patient, fax your appeal to us:

For standard coverage redeterminations: 1-855-839-3878

For Urgent (expedited) coverage redeterminations: 1-855-839-3879

Call our Part D appeals department for expedited appeal requests at 1-855-508-1718

Mail your coverage redetermination to us at:

PHP Care Complete
Rx Redetermination
200 Stevens Drive
Philadelphia, PA 19113


Grievances

Call Provider Services at 1-855-747-5483 or TTY/TDD: 711

Fax your grievance to us.  Our fax number is 1-855-619-4678

Write your grievance and mail it to us at:

PHP Care Complete FIDA-IDD
Grievance Department
2929 Expressway Drive North
Suite 210
Hauppauge, NY 11749

Most grievances are answered in 30 calendar days. If possible, we will answer you right away. If you call us with a grievance, we may be able to give you an answer on the same phone call.

If you need a response faster because of the health of your patient, we will give you an answer within 48 hours after we get all necessary information (but no more than 7 calendar days from the receipt of your grievance).


You can get this information for free in other languages. Call 1-855-747-5483, and 711 for TTY users, during the hours of 8:00 am to 8:00 pm, 7 days a week. The call is free.

Puede obtener esta información gratis en Español. Llame a Servicios del Participante al 1-855-747-5483 durante las horas de 8:00 am a 8:00pm, 7 días de la semana. Usuarios de TTY llamar al 711. La llamada es gratuita.

Lei puo ottenere questi informazioni in Italiano gratuitamente. Chiama il Servizio Partecipanti a 1-855-747-5483 durante il periodo da 8AM a 8PM, 7 giorni alla settimana. TTY utilizzatori dovressi chiamare 711. La chiamata è gratis.

Ou ka jwenn enfòmasyon sa a pou gratis nan kreyòl ayisyen. Rele sèvis patisipan nan 1-855-747-5483 les heures de 8:00 je pou 8:00 pm, 7 jou nan semenn nan. Utilisateurs TTY ta dwe rele 711. Apèl gratis.

Вы можете получить эту информацию бесплатно на русском языке. Звоните в Отдел обслуживания участников плана по телефону 1-855-747-5483 с 8:00 утра до 8:00 вечера, 7 дней в неделю. Пользователи TTY звоните по телефону 711. Звонок бесплатный.

您可免費獲得到以上的中文資訊, 請致電參與者服務電話 1-855-747-5483,辦公時間為上午8時到下午8時,每週7天。聽力語言殘障服務專線(TTY)用戶請撥打711。該電話為免付費通話。

한국어로 된 정보를 무료로 얻을 수 있습니다. 주 7일 오전 8시에서 오후 8시 사이에1-855-747-5483 번(TTY 사용자는 711번)으로 문의해 주십시오. 통화는 무료입니다.

You can get this information for free in other formats, such as large print, braille, or audio. Call 1-855-747-5483 and 711 for TTY users during the hours of 8:00 am to 8:00 pm, 7 days a week. The call is free.