|
PHARMACY / PROVIDER DOCUMENTS |
|
|
|
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 |
|
|
|
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 |
|
|
|
Pseudo-DIN List |
|
NexgenRx PIN LIST January 2018 |
|
|
|
Dental Practitioners EFT Enrollment |
|
Dental Practitioners – Direct Deposit EFT Payment Request Form |
|
Demande de Dépôt Direct de Paiement Pour les Services Dentaires |
|
|
|
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 |
|
|
|
Plan Member Documents |
|
|
|
DSM Diabetes |
|
DSM Cardiovascular Wellness |
|
DSM Musculoskeletal Disorder |
|
|
|
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 |
|
|
|
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 |
|
|
|
Group Benefits Request for Drug Exception |
|
Group Benefits Request for Drug Exception |
|
Demande d'exception pour médicament non-éligible, Bénéfices de Group |
|
|
|
Prior Authorization Forms |
|
|
