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Provider Resources
Viva Medicare Resources
Viva Medicare Resources
Authorization/Pre-Certification Forms
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Imaging Request Form
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Referral Authorization Form
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DME Form
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Inpatient/Outpatient Precertification Form
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Rehabilitation Precertification Forms
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SNF/Rehab Discharge Documentation
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Provider Reference Guide
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Policy for Mechanical Stretching Devices
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Policy for Proton Beam Radiotherapy
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Policy for Intrauterine Device for Endometrial Hyperplasia
Behavioral Health
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Psychological-Neurological Testing Request Form
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Transcranial Magnetic Stimulation Authorization Request Form
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Electroconvulsive Therapy (ECT) Authorization Request Form
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Mental Health Continued Stay Review Fax Form
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Substance Abuse Initial Review Fax Form
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Substance Abuse Continued Stay Review Form
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Discharge Orders Fax Form
Care Plans
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QI - Care Plan (Member)
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QI - Care Plan (Cancer)
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QI - Care Plan (Congestive Heart Failure)
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QI - Care Plan (Diabetes)
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QI - Care Plan (High Blood Pressure)
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QI - Care Plan (Stroke)
Pharmacy
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Medical Benefit Drug Prior Authorization Form
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Medicare Part D - Coverage Determination Form
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Hospice Beneficiary - Medicare Part D Request Form
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Medical Drug Policies
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HelpScript FAQ
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CMS Medicare Coverage Database (MCD)
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National Comprehensive Cancer Network
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Medical Preferred Drug Program with Step Therapy - Medicare
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Viva Medicare Special Needs Plan Model of Care (SNP MOC) Provider Training
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Medicare Part D Opioid Policies - Information for Prescribers
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Medicare Part D Opioid Policies - Information for Pharmacists
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Member Opioid Educational Flyer
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Member Opioid Educational Letter
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Real-Time Prescription Benefit Overview
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FAQ Prescription Benefits
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Compatible EHR Systems
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2024 Diagnosis Code Guide
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2026 Viva Medicare Plus, Premier, Extra Value, Classic, Extra Care, and Infirmary Health Advantage Plans Pharmacy Directory
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2027 Viva Medicare Plus, Premier, Extra Value, Healthy Living, Classic, Extra Care, and Infirmary Health Advantage Plans Pharmacy Directory
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2026 Viva Medicare Extra Value and Extra Care Plans Formulary (List of Covered Drugs)
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2026 Viva Medicare Plus, Premier, Classic, & Infirmary Health Advantage Plans Formulary (List of Covered Drugs)
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2027 Viva Medicare Plus, Premier, Classic, & Infirmary Health Advantage Plans (Non-SNP) Formulary
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2027 Viva Medicare Extra Value and Extra Care (SNP) Formulary
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2027 Viva Medicare Healthy Lifestyles Plan (C-SNP) Formulary
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2026 Viva Medicare Extra Value and Extra Care (SNP) Step Therapy Criteria
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2026 Viva Medicare Plus, Premier, Classic, & Infirmary Health Advantage Plans (Non-SNP) Step Therapy Criteria
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2027 Viva Medicare Healthy Lifestyles Plan (C-SNP) Step Therapy Criteria
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2027 Viva Medicare Extra Value and Extra Care (SNP) Step Therapy Criteria
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2027 Viva Medicare Plus, Premier, Classic, & Infirmary Health Advantage Plans (Non-SNP) Step Therapy Criteria
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2026 Viva Medicare Plus, Premier, Classic and IH Advantage (Non-SNP) Cumulative Changes
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2026 Viva Medicare Extra Value and Extra Care (SNP) Cumulative Changes
Other
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Provider Compliance Training
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InterQual Transparency Tool
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EFT - Electronic Payment Flyer
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Request for Reopening vs. Appeal
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Waiver of Liability Statement Form