Forms and Online Requests
Health Risk Assessment
Doctors HealthCare Plans is focused on providing the right care to help your patients (our members) stay as healthy as possible. The Health Risk Assessment (HRA) or Health Risk Assessment Tool (HRAT) is used to survey your patients (our members) and obtain information about their health and lifestyle. We can then use that information to jointly develop personalized care plans.
HRAs should be completed within 90 days of enrollment and must be conducted annually or periodically as needed. Completed HRAs should be faxed to Doctors HealthCare Plans at (786) 279-8208.
Please use the links below to download the following forms as PDF files:
Medication Reconciliation Post-Discharge
Medication Reconciliation can prevent adverse drug effects events, especially for people with multiple prescription medications and post-discharge. A potentially negative occurrence can occur if medications are not used and monitored appropriately.
Part D – Coverage Determination
A coverage determination is necessary when a formulary medication requires a Prior Authorization, Step Therapy and/or Quantity Limit. Exceptions, such as Tiering exceptions and Formulary exceptions, also require coverage determination. A tiering exception is when you believe a member should get a drug at a lower cost share. A formulary exception is when you believe a member needs a drug that is not on the plan’s formulary. All exception requests must be supported by a statement by the prescribing physician. Standard Coverage Determinations will be made within 72 hours. Expedited Coverage Determinations will be made within 24 hours.
Ways to Request a Coverage Determination
- CALL: Contact Member Services toll-free at 833-342-7463 (TTY: 711), 7 days a week 8 a.m. to 8 p.m;
- ONLINE SUBMISSION: Submit your Coverage Determination request online (Coverage Determination request online);
- FAX: Download and complete a Coverage Determination form and fax the completed form to 866-291-3725. (English / Español);
- MAIL: Mail the completed request form to the plan’s Pharmacy Department address:
Doctors HealthCare Plans, Inc.
Attn: Pharmacy Department
2020 Ponce De Leon Blvd., PH 1
Coral Gables, FL 33134
2021 SNP Model of Care (MOC) Training
2021 MOC Training Attestation and Evaluation
Providers are required to undergo SNP Model of Care Training. This training provides an overview of SNPs and the responsibilities physicians and other participating health care providers have for their SNP patients
Claim Disputes for Participating Providers
Participating providers may submit a Claim Dispute within one hundred twenty (120) calendar days from the date of the corresponding Remittance Advice. Claim Disputes submitted past one hundred and twenty (120) days from the date of the corresponding Remittance Advice will be considered a late filing and shall be rejected.
Doctors HealthCare Plans, Inc. encourages you to submit your Claim Disputes online using the link: https://www.doctorshcp.com/claim-dispute-form-par/
If you cannot submit your Claim Dispute online, you may use the Claim Dispute Form for Participating Providers. Supporting documentation must include the Remittance Advice and medical records; additional evidence may be required in specific cases. Incomplete submissions will not be accepted. Please allow sixty (60) days for processing.
You may submit your Claim Dispute to:
Doctors HealthCare Plans. Inc.
Attn.: Provider Inquiry Unit
2020 Ponce de Leon Blvd, PH1
Coral Gables, FL 33134
Bills of Rights
Florida law requires that your healthcare provider or healthcare facility recognize your rights while you are receiving medical care and that you respect the healthcare providers’ or facility’s right to expect certain behavior on the part of patients.
Last Updated: 09/07/2021