The SilverScript Medicare Part D Appeals Process (Redetermination)
What is a SilverScript Medicare Part D Appeal?
If you disagree with a decision we make in response to your original request for a Coverage Determination,
you have the right to ask us for a Redetermination by submitting an Appeal. An Appeal is the process of
asking us to reconsider our initial Coverage Determination decision. There are additional levels of
Medicare Part D Appeals available to you if you disagree with a Redetermination.
For doctors or other prescribers to request a Redetermination by Electronic Prior Authorization (ePA) if your coverage determination
was previously requested by ePA:
Your provider should visit their local electronic health record (EHR) platform or dedicated ePA
portal, such as covermymeds®, Surescripts®, or Novologix®.
To request a Redetermination by phone: Call toll-free,
Phone Number1-866-235-5660, 24 hours a day, 7 days a week. TTY users should call TeleType Number 711.
To fax a written request for Redetermination: Fax toll-free: Number1-855-633-7673.
To mail a written request for Redetermination:
SilverScript Insurance Company
P.O. Box 52000 MC109
Phoenix, AZ 85072-2000
To submit your request electronically, use the Drug Search and Pricing Tool
Standard and Expedited Redetermination Requests
Standard Redetermination Request
We will make our decision on a standard request within 7 days of receipt.
Expedited Redetermination Request
You have the option to make an expedited request (one that requires a faster response) if you or your doctor
or other prescriber believes your health could be seriously harmed by waiting up to 7 days for a decision.
If your request to expedite is granted, we will give you a decision no later than 72 hours after we receive
Note: If your doctor or other prescriber requests or supports your request for an expedited Redetermination
and your doctor or other prescriber indicates that waiting for a standard decision could seriously harm your
health or your ability to function, we will automatically give you an expedited request.
To file a Reconsideration Form by mail, send the form in writing to:
Maximus Federal Services
To request a Reconsideration Form by phone:
To Fax a request for Reconsideration Form:
c/o Part D Drug Appeals
3750 Monroe Ave, Suite 703
Pittsford, NY 14534-1302
SilverScript Medicare Part D Appeals Process and Plan Performance
As a SilverScript member, you have the right to receive additional plan information from us in a way
that works best for you, including:
- Your plan's financial condition
- The number of Appeals made by plan members
Your plan's Star Performance ratings–including how the plan has been rated
by plan members and how it compares to other Medicare prescription drug plans.