PHARMACY / PROVIDER DOCUMENTS |
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Pharmacy Agreements |
Pharmacy Provider Agreement - English |
Pharmacy Provider Enrollment Quebec Only - English |
Change of Ownership Provider Agreement - English |
Change of Ownership Provider Application Quebec Only - English |
Entente de Fournisseur l'exception du Québec Change of Ownership Provider Agreement Not for Quebec - French |
Entente de Fournisseur l'exception du Québec Provider Agreement Not for Quebec - French |
Demande de Pharmacie Prestataire Québec seulement Provider Enrollment Quebec Only - French |
Changement de RAMQ Provider Enrollment Change of Ownership Quebec Only - French |
Pharmacy Provider Provisions |
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Pharmacy Payment Information |
Quick Reference to Explanation of Payments for Pharmacies - 2012 Payment Schedule 1st & 16th of each month |
AIDE-MÉMOIRE POUR OBTENIR L’EXPLICATION DU PAIEMENT DES HONORAIRES DE PHARMACIE |
Payment Schedule Calendar 2011 – 12 Onward |
Payment Schedule Calendar 2010 |
Pharmacy – Banking Payment Information Change Form – English |
Pharmacie – Changement D’Information Bancaire - French |
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Pseudo-DIN List |
NexgenRx PIN LIST January 2019 |
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Dental Practitioners EFT Enrollment |
Dental Practitioners – Direct Deposit EFT Payment Request Form |
Demande de Dépôt Direct de Paiement Pour les Services Dentaires |
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Health Care Provider Documentation |
Electronic Transmission Authorization and Consent Form |
Plan Member News Release |
Formulaire d'autorisation de transmission électronique et de consentement |
Plance le portail du fournisseur de soins de santé |
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Plan Member Documents |
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DSM Diabetes |
DSM Cardiovascular Wellness |
DSM Musculoskeletal Disorder |
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Administration Forms |
Group Coverage Enrollment Form for Health, Dental and insurance benefits |
Forme Demande d'Assurance Collective pour la santé, dentaires et d'assurance |
Direct Deposit Form |
Formulaire de dépôt direct |
Group Benefits Change Form - Fillable |
Authorization_to_release_information_English |
Authorization_to_release_information_French |
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Claim Forms |
Drug and Extended Health Care Claim Form - English |
Drug and Extended Health Care Claim Form - French |
Dental Claim Form - English |
Dental Claim Form - French |
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Group Benefits Request Special Evaluation Drug Exception for Members Administrators Clients Forms |
Group Benefits Request Special Evaluation Drug Exception for Members and Administrators Clients |
Demande d'exception pour médicament non-éligible, Bénéfices de Group _ Group Benefits Request Special Evaluation Drug Excp |
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HealthWATCH FOR BUSINESS Program Forms |
HealthWATCH FOR BUSINESS specialty solutions Program Request for Exception . |
HealthWATCH FOR BUSINESS specialty solutions Program Request for Exception DEMANDE D'EXEMPTION . |
HealthWATCH for Business® Tier Drug Exception Request |
HealthWATCH for Business® Tier Drug Exception Request _ DEMANDE D'EXCEPTION DE MÉDICAMENT |
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Prior Authorization Forms |
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