Allwell Member ID Card Quick Reference Guide
Allwell Member ID Card Quick Reference Guide
Use this Member ID card quick reference guide for Allwell Medicare patients. Key ID card elements are highlighted below to help you find the information you need for easier claims filing and effective care management.
SAMPLE CARD FRONT
Plan Name
Product Name
SAMPLE CARD BACK
Eligibility Confirmation
Part D Drug Claims Address
Member Information
Provider Information
HMO CMS#: XXXXX-XXX Effective:
MEMBER INFORMATION Name: Member ID#: Issuer ID:
PROVIDER INFORMATION PCP Name: < > PCP Phone: < >
PHARMACY INFORMATION
Rx Claims Processor: RXBIN: RXPCN: RXGRP:
Plan Contract Number Member Effective Date
Prior Authorization or Case Management
Pharmacy Prior Authorization
FOR MEMBERS Member Services: (TTY: 711) 24-hr Nurse Advice:
FOR EMERGENCIES Dial 911 or go to the nearest Emergency Room (ER).
FOR PROVIDERS
For eligibility:
1-855-766-1452
Prior authorization or case
management referrals: 1-855-766-1452
Pharmacy prior auth: 1-844-202-6824 For help: (PHARMACY USE ONLY) 1-888-865-6567
Submit Part D Drug Claims to: Allwell ? Attn: Pharmacy Claims
MEDICAL CLAIMS
EDI Payor Allwell ? Attn: Claims ID: P.O. Box 3060 Farmington, MO 63640-3822
Pharmacy Claims Filing Information
Medical Claims Address
Please contact Provider Services
for additional assistance by calling: 1-855-766-1452
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