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Fee-for-service medical prior approval (HFS 1409) for non-optometric services; medications use the pharmacy forms instead. Source is the HFS 1409 instructions revised November 2015 — confirm current routing before relying on it.

Fee-for-service optometric prior approval requests on the HFS 1409. Source instructions revised November 2015.

HFS phone directory lists 1-877-782-5565 for Claims Processing, the Provider Billing Hotline and Provider Participation (fee-for-service Illinois Medicaid). MCO members' claims go to the MCO.

Provider eligibility inquiry hotline listed in the HFS medical programs phone directory; MEDI web eligibility is also available.

CMS ACO ID A5816. 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.

General information mailbox on the contact page; not for claims, eligibility or authorizations.

This is a self-funded plan administrator, so each employer plan differs: the provider number, claim address and payer ID printed on the member's ID card are authoritative. Contact page: members call 800-827-7223 or the number on the back of the ID card for help with care or a bill; myplan@imagine360.com is the member email. Providers are directed to a web contact form (no provider phone, fax or claim address is published). Imagine360 acts as TPA on its core offering.

Iowa HHS identifies this center for program information and application assistance. Enrollment requires program assessment.

Participants, family or representatives may give a grievance to staff in person, by phone or in writing. Published fax is the center fax.

Center information and enrollment inquiry; service area is limited to selected ZIP codes.

Published Nebraska center grievance route; participant or representative may contact staff in person, by phone or in writing.

Iowa HHS identifies this center for program information and application assistance. Enrollment requires program assessment.

Participants, family or representatives may give a grievance to staff in person, by phone or in writing. Published fax is the center fax.

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.

Imperial Health Plan of California Medicare Advantage; source is the 2025 Medicare provider manual (still linked on the current provider page). Office Ally payer ID IHP01 (Imperial Health Holdings Medical Group uses HHMG and PO Box 60075).

Imperial Health Plan of California Medicare Advantage; source is the 2025 Medicare provider manual (still linked on the current provider page). Fax the case management referral form with medical records.

Imperial Health Plan of California Medicare Advantage; source is the 2025 Medicare provider manual (still linked on the current provider page). Provider network management, contracting and general provider questions; Monday–Friday 8:00 a.m.–5:00 p.m. PST.

Imperial Health Plan of California Medicare Advantage; source is the 2025 Medicare provider manual (still linked on the current provider page). Member eligibility verification.

Imperial Health Plan of California Medicare Advantage; source is the 2025 Medicare provider manual (still linked on the current provider page). Inpatient UM fax.

Mail the completed Imperial provider claim dispute form with supporting documentation.

Contracting and provider questions for Imperial exchange (individual & family) and small group products.

Pre-certification referral form: urgent (expedited) requests by fax; call the main number option 1 to check referral status. A second standard fax (888-910-4412) also appears on the form.

Imperial Health Plan of California Medicare Advantage; source is the 2025 Medicare provider manual (still linked on the current provider page). UM phone and standard outpatient fax; do not combine multiple specialties in one fax.

Imperial Insurance Companies individual & family (exchange) plans sold in Arizona, Nevada, Texas and Utah: provider services, contracting questions and complex case management referrals. Claims address depends on the member's coverage (see ID card). Not for Imperial Medicare Advantage (California).

CMS ACO ID A4945. 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.

CMS ACO ID A5523. 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.

Incyte contact page, United States: 1-855-4-MEDINFO for medical information, adverse events (medication side effects) or product quality complaints. Not the IncyteCARES access/reimbursement hub.

Current June 2026 forms offer enrollment and a benefits-investigation-only request. Use the JAKAFI or JAKAFI XR form matching the prescription; the shared contact does not make formulations or their prescription fields interchangeable. PAP requires separate financial information and review.

Official enrollment page provides separate online and printable choices for JAKAFI and JAKAFI XR. Choose the correct formulation at this gateway. No enrollment form was completed or submitted.

Page 5 of both current forms gives this number for withdrawal of consent to processing health data described in that consent. It is separate from enrollment, benefits investigation and fax intake.

Page 2 permits HIPAA authorization withdrawal by this program phone or postal address. Page 3 directs cancellation of income-verification authorization in writing to the same address. The different 6000 Park Lane address is specifically for supporting income documents.

The published email applies to the two optional communication permissions. HIPAA and income-verification authorization withdrawal use the distinct instructions on the same form.

Current March 2026 form directs completed form and PA/appeal decision copies to this fax. Its PAP is for uninsured or Medicare Part D patients with financial need; commercially insured patients are excluded from this PAP. The source separately directs required income documents to the listed mail destination. This is not the commercial copay program.

Current general support page prints July 2026 and lists Brightscrip contacts. The vitiligo savings-card entry page publishes a different contact pair; preserve the exact program/page context. No precedence between those current pages is inferred.

Current vitiligo savings-card entry page prints July 2026 and lists Upscript contacts. Its role is kept separate from Brightscrip contacts on the general patient-support page; use the channel attached to the actual program page.

Perinatal case management program. Philadelphia-area number 215-241-2198; outside Philadelphia 1-800-598-2229.

Precertification for CT/CTA, MRI/MRA, PET, nuclear cardiology, facility sleep studies, CPAP titration and sleep equipment, Cardiology and Musculoskeletal UM programs. Carelon is an independent company.

Email for credentialing/re-credentialing application status. Corrections go to CredOps@ibx.com.

Corrections to credentialing applications by email or fax.

Report credentialing violations; not for application status.

Fax for the IBX Direct Ship Drug Program (www.ibx.com/directship).

Precertification for nonemergent outpatient radiation therapy and precertification/prepayment review for genetic/genomic, molecular and cytogenetic tests. eviCore is an independent company.

FEP member customer service line listed on the IBX provider contact page (Philadelphia area).

Case and condition management / health coaching, 24 hours a day, 7 days a week.

24/7 line listed for Independence Administrators members' mental health/substance use. Keystone Health Plan East members with Caring Foundation benefits: 1-800-294-0800.

Medicare Advantage HMO/POS customer service; Philadelphia area 215-241-2365, outside Philadelphia 1-800-645-3965.

Behavioral health and Applied Behavior Analysis customer service and precertification; behavioral health clinician on call 24 hours. Hours Mon. – Fri., 8 a.m. – 6 p.m.

Medicare supplement customer service.

Support for the Provider Engagement, Analytics & Reporting (PEAR) portal, where precertification requests are entered (PEAR Practice Management).