I am already enrolled - AdvantageBlue PFFS

Appeals and Exceptions

Medicare Advantage private fee-for-service plans have many rules. You can ask Medi-CareFirst to make exceptions to those rules. You can also appeal our decision. Below are links to information on this site about those rules:

Grievances

• What is a grievance?  
• How do I report a grievance?

Organization Determination

• What is an organization determination?
• How do I ask for an organization determination?

Coverage Determination

• What is a coverage determination?
• How do I ask for a coverage determination?

Exceptions

• What is an exception?
• How do I ask for an exception? 

Appeals

• What is an appeal?
• How do I ask for an appeal? 

Prior Authorization

• What is prior authorization?
• How do I get prior authorization? 

Appointing a Representative

• What is a representative?
• How do I appoint a representative? 

Forms

Our Forms and Applications page provides you with links to all the AdvantageBlue PFFS forms available on our site.

More Information

More information about the AdvantageBlue PFFS grievance, appeals, exceptions and coverage determination processes is available in your Evidence of Coverage.

• AdvantageBlue PFFS EOC  (780KB, 128 pgs., PDF)

Viewing and printing the Evidence of Coverage requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.