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Determination Request

Request for Medicare Prescription Drug Coverage Determination

Coverage Determination Online Form

Or Click the below link to download a PDF copy of the Coverage Determination Form.

Coverage Determination

This form may be sent to us by mail or fax:

Address
Alignment Health Plan
Attn: Clinical Review Department
2900 Ames Crossing Road
Eagan, MN 55121
 

Fax Number:
1-800-693-6703

You may also ask us for a coverage determination by phone at Toll Free: 1-844-227-7616, 24 hours a day/7 days a week. TTY users should call 711 or through our website at alignmenthealthplan.com.