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| Part C | Part D Prescription Drug Coverage |
|---|
| Evidence of Coverage (EOC) |
| Part C explanation of benefits (EOB) |
| Annual notice of change (ANOC) |
| Pre-Enrollment checklist (PECL) |
| Summary of Benefits (SB) |
| Enrollment Form |
| Enrollment Notice |
| Disenrollment Notice |
| Mid-Year Change Notification |
| Non-renewal Notice |
| Provider Directory |
| Provider Termination Notice |
| Star Ratings Document |
| Organization Determination Notice |
| Excluded Provider Notice |
| Notice of Denial of Medical Coverage or Payment (NDMCP) (also known as the Integrated Denial Notice (IDN)) |
| Notice of Medicare Non-Coverage (NOMNC) |
| Detailed Explanation of Non-Coverage (DENC) |
| Appointment of Representative (AOR) |
| An Important Message From Medicare About Your Rights (IM) |
| Detailed Notice of Discharge Form (DND) |
| Medicare Outpatient Observation Notice (MOON) |
| Appeal and Grievance Data Form |
| Request for Administrative Law Judge (ALJ) Hearing |
| Attorney Adjudicator Review in Lieu of ALJ Hearing |
| Notice of Right to an Expedited Grievance |
| Waiver of Liability Statement |
| Notice of Appeal Status |
| Notice of Dismissal of Appeal |
| Member ID |
| VBID Letters |
| Evidence of Coverage (EOC) |
| Part D explanation of benefits (EOB) |
| Annual Notice of Change (ANOC) |
| Pre-Enrollment Checklist (PECL) |
| Summary of Benefits (SB) |
| Enrollment/Election form |
| Enrollment Notice |
| Disenrollment Notice |
| Formulary |
| Low Income Subsidy (LIS) Notice |
| Low Income Subsidy (LIS) Rider |
| Midyear Change Notification |
| Non-renewal Notice |
| Part D Transition Letter |
| Pharmacy Directory |
| Prescription transfer letter |
| Star Ratings Document |
| Coverage Determination Notices |
| Excluded Provider Notices |
| Notice of Denial of Medicare Prescription Drug Coverage |
| Medicare Prescription Drug Coverage and Your Rights |
| Medicare Part D Coverage Determination Request Form |
| Request for Additional Information |
| Notice of Right to an Expedited Grievance |
| Notice of Inquiry |
| Notice of Case Status |
| Request for Reconsideration of Medicare Prescription Drug Denial |
| Notice of Redetermination |
| LEP Reconsideration Request Form |
| Request for Administrative Law Judge (ALJ) Hearing or Review of Dismissal |
| Appointment of Representative (AOR) |
| Comprehensive Medication Review - written summary (MTM Program) |
| Safe Disposal Information (MTM Program) |
| Member ID |