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Current forms publish the same Suite 300 mailing destination for authorization revocation. Name the applicable program and follow its instructions. The forms also permit product-specific phone/fax contact through their respective enrollment contacts.

Published in the pharmacist coordination-of-benefits processing instructions at the coupon destination currently linked by EPS. The destination retains copyright 2023; the current link and older document vintage are recorded separately. No reimbursement amount or individual qualification is promised.

Published digital program-enrollment entry. Public application shell only; sign-in and submission were not tested. Follow formulation-specific offerings in the current form.

Current July 2026 form covers LEQEMBI infusion and LEQEMBI IQLIK with formulation-specific PAP, temporary supply and copay offerings. Select the appropriate sections and secure the required patient authorization. Current EPS page identifies LEQEMBI Companion and access/reimbursement support; enrollment does not assure coverage or program eligibility.

Current official page links this distinct IQLIK copay entry. It is not generalized to infusion copay enrollment. Public coupon-portal shell retrieved; no eligibility determination or submission was tested.

Medical records department for El Camino Hospital Los Gatos. The page lists one fax for submitting completed authorizations (see Mountain View line).

Medical records department for El Camino Hospital Mountain View: authorization form questions, fees and pickup arrangements; fax completed authorizations. No fee for records released to a doctor's office or facility.

Medical staff office at the Los Gatos campus.

Medical staff office for privileges and medical staff matters at the Mountain View campus.

El Camino Hospital Patient Accounts customer service: bill and payment-option questions, financial assistance/charity care information, free policy copies by mail and accessible-format notices.

Specific estimates of potential patient financial liability.

Patient registration representatives, Los Gatos campus.

Patient registration representatives for pre-admission forms and insurance card submission before a hospital stay.

Help desk for medical staff remote sign-in (Follow Me Desktop).

Published in the California Department of Public Health immunization-program directory. Confirm the requested vaccine, service, appointment and jurisdiction with the office. This source does not establish general billing or insurance-plan support.

Published in the California Department of Public Health immunization-program directory. Confirm the requested vaccine, service, appointment and jurisdiction with the office. This source does not establish general billing or insurance-plan support.

CDPHE county directory main administrative referral. Published street location is an office, not a guarantee of every service there. Source page shows no publication date.

Use the product-specific El Paso Health line matching the member’s ID card. Texas tagging does not establish a statewide service area.

The source also gives local Provider Relations number 915-532-3778. Use the product-specific El Paso Health line matching the member’s ID card. Texas tagging does not establish a statewide service area.

Inpatient admission notifications. Local fax withheld: PA page shows 915-200-5278 while the Quick Reference Guide shows 915-298-5278.

Long-term services and supports requests for STAR+PLUS members.

The source also gives local Provider Relations number 915-532-3778. Use the product-specific El Paso Health line matching the member’s ID card. Texas tagging does not establish a statewide service area.

Electronic payer IDs: STAR and STAR+PLUS EPF02; CHIP EPF03 (Availity). General correspondence: P.O. Box 971100, El Paso, TX 79997-1100.

Outpatient drug PA; clinical staff 24/7.

Outpatient/elective PA fax (toll-free fax 1-844-298-7866), 24/7 fax server. Telephonic requests: STAR/CHIP 915-532-3778; STAR+PLUS 1-833-742-3127. Portal submission also available.

Shared provider-page route; confirm the product’s appeal instructions and required documents. Use the product-specific El Paso Health line matching the member’s ID card. Texas tagging does not establish a statewide service area.

The page directs follow-up questions to Provider Relations. Use the product-specific El Paso Health line matching the member’s ID card. Texas tagging does not establish a statewide service area.

Provider Relations Department email (STAR/CHIP 915-532-3778; STAR+PLUS 1-833-742-3127).

The source also gives local Provider Relations number 915-532-3778. Use the product-specific El Paso Health line matching the member’s ID card. Texas tagging does not establish a statewide service area.

The source also gives local Provider Relations number 915-532-3778. Use the product-specific El Paso Health line matching the member’s ID card. Texas tagging does not establish a statewide service area.

Contact page lists this address for corporate headquarters inquiries; not a referral address.

Elara Caring has no published central referral phone or fax; the Refer a Patient hub links to separate forms for skilled home health, hospice care, personal care services and behavioral health, and the Contact page points to a "Find a Local phone/fax" page for branch numbers. Page blocks scripted fetches; links read via WebFetch.

Published county department contact in the Georgia DPH county directory, District 10-0. County association follows the named directory record; it does not establish every program's eligibility or service area. The directory may publish a shared regional number. Confirm the office and purpose when connected. The listed fax has no specialized claims or medical-records submission purpose stated.

CDPHE county directory main administrative referral. Published street location is an office, not a guarantee of every service there. Source page shows no publication date.

Published toll-free alternative: 888-343-8209. This is Elderhaus PACE, operated by EveryAge; separate Adult Day Services and Home Care listings are not additional PACE organizations.

Participant privacy notice effective February 16, 2026 directs records-access questions to the Privacy Officer and publishes this contact for privacy information/complaints. Written access requests are required; no separate records fax or email was established.

Carelon (formerly Beacon) handles behavioral health only for the Elderplan Plus Long-Term Care (Medicaid Advantage Plus) plan.

DentaQuest is Elderplan's dental vendor.

Elderplan high-tech radiology vendor; Premier claims inquiries are 1-800-610-6114.

Electronic claims: Elderplan Payer ID 31625 via iEDI (Optum) or TransShuttle (Axiom). Claims needing operative reports, EOBs or attachments must be submitted on paper. Claim status: Provider Services or the Provider Web Portal.

Elderplan pharmacy benefit manager for Part D prior authorization / coverage determinations. TTY 711.

Per the 2026 provider manual, prior authorization requests are called in to the Medical Management Department via Provider Services. An authorization request form (Sept 2025) is posted under Provider Materials. High-tech radiology is through Premier (see separate line).

Elderplan (MJHS) provider services for benefits, eligibility, claims status and pre-authorization questions. The same number (without option 2) is Elderplan member services. HomeFirst MLTC member services is 1-877-771-1119.

CMS ACO ID A5191. Public reporting / administrative contact from the CMS PY2026 dataset, modified April 16, 2026. This is not a claims, eligibility, enrollment, or urgent clinical line. State tags identify states containing counties where more than 1% of assigned beneficiaries reside; they are not a statewide service-coverage or eligibility guarantee. The ACO reporting website was supplied in the dataset and was not individually reviewed in this batch.

Center phone/address on the Element Care PACE locations list. The page notes alternative care sites offer more limited services than a full PACE center.

Center phone/address on the Element Care PACE locations list. The page notes alternative care sites offer more limited services than a full PACE center.

Page states service area is all of Essex County, the Merrimack Valley and parts of Greater Boston (north-east Middlesex County); a ZIP/town service area list is on the site. TTY 711. Helps with eligibility and MassHealth application.

Center phone/address on the Element Care PACE locations list. The page notes alternative care sites offer more limited services than a full PACE center.

Center phone/address on the Element Care PACE locations list. The page notes alternative care sites offer more limited services than a full PACE center.

Center phone/address on the Element Care PACE locations list. The page notes alternative care sites offer more limited services than a full PACE center.