Visit us at our NEW location: 2270 NW Aviation Drive, Suite 3
Across from Aviation Suites at Roseburg Regional Airport
Questions? or To request an Exception or Appeal Call Customer Service:
Toll-Free: 877-672-8620 TTY: 800-735-2900
Monday - Friday, 8am to 5pm PT

Provider Forms
EDI (Electronic Claims Submission and Eligibility) Application Forms
Electronic Payment Forms
Fraud Waste and Abuse Training		 Part C (Medical) and D (Pharmacy) Authorization Request Forms
Select Plan Year
2010
Select Plan Year
2010
H3814_MKG 50_03
CMS Approved: 10/20/09
Date Last Updated: 06/16/2010