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
MC109 P.O. Box 52000
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 believe 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 your request.

Note: If your doctor’s or other prescriber’s 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.


This chart provides an overview of the Appeals process

Your request What you or your prescriber can do What your plan will do
Reconsider an unfavorable Coverage Determination Submit an Appeal within 60 days from the date of the notice of the Coverage Determination asking us to reconsider our decision. Respond with a Redetermination based on our interpretation of how your plan benefits apply to your specific situation.
Reconsider an unfavorable Coverage Redetermination Request an Appeal conducted by an Independent Review Entity (IRE) not connected with your plan. We will abide by the final outcome of your Reconsideration by the IRE.
Appeal a Redetermination Decision rendered by the Independent Review Entity (IRE) Submit a request for Reconsideration within 60 days from the date you received the written Redetermination notice from the IRE. We will abide by the final outcome of your Reconsideration by the IRE
  • This chart provides an overview of the Appeals process
    • Your request
    • Reconsider an unfavorable Coverage Determination
    • What you or your prescriber can do
    • Submit an Appeal within 60 days from the date of the notice of the Coverage Determination asking us to reconsider our decision.
    • What your plan will do
    • Respond with a Redetermination based on our interpretation of how your plan benefits apply to your specific situation.
    • Your request
    • Reconsider an unfavorable Coverage Redetermination
    • What you or your prescriber can do
    • Request an Appeal conducted by an Independent Review Entity (IRE) not connected with your plan.
    • What your plan will do
    • We will abide by the final outcome of your IRE Appeal.
    • Your request
    • Appeal a Reconsideration Decision rendered by the Independent Review Entity (IRE)
    • What you or your prescriber can do
    • Submit a request for Reconsideration within 60 days from the date you received the written Redetermination notice from the IRE.
    • What your plan will do
    • We will abide by the final outcome of your Reconsideration by the IRE.

To file a Reconsideration Form by mail, send the form in writing to: Maximus Federal Services
C/O Part D Drug Appeals
3750 Monroe Ave, Suite 703
Pittsford, NY 14534-1302


To request a Reconsideration Form by phone:
To Fax a request for Reconsideration Form:

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.

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