production view - amerigroup

PRODUCTION VIEW

PCP:

CareMore Health - Arizona

RxBIN: 020115RxPCN: ISRxGRP: WM2A

Issuer ID: 80840

Member ID:

Amerivantage Lung Care

CMS H1423-PBP: 001-000

Office Visit Copay:Specialist Visit Copay:Emergency Room Copay:Preventive Copay:livehealthonline.com

Plus (HMO C-SNP)

RxID:

$0$35

$120$0

X634494900001

Members: Present this ID card to your

Customer Service:

or supplies. See your Evidence of Coverage forcovered services.Providers and Hospitals: Prior authorizationis required for all non emergency admissionsand certain services. For emergency

Claims: Amerigroup, P.O. Box 366Artesia, CA 90702-0366

Pharmacy Claims: P.O. Box 52077Phoenix, AZ 85072-2077

Use of this card by any person other than the member is fraud 11/01/2020

admissions, please call within 24 hours

EDI Information : Payer ID - CARMO

1-888-816-2790711

healthcare provider before you receive services

TTY:Pharmacy Member Srvc: 1-833-498-1582Help for Pharmacists: 1-833-377-4266

1-888-291-13581-888-700-09921-855-658-92491-855-741-4985

Providers:Dental:24/7 NurseLine:SilverSneakers:

of treatment.

amerigroup.com/medicare

Mail to AddressMember NameMember IDJob ID

Processed DateExpected Mail DateActual Mail Date2931296

11/01/202011/05/2020

Card Front Card Back

PRODUCTION VIEW

PCP: PCP Phone: (CareMore Health - Arizona


Issuer ID: 80840

Member ID:

Amerivantage Diabetes

CMS H1423-PBP: 002-000


Care Plus (HMO C-SNP)

RxID:

$0$35

$120$0

X634924500001


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-800-589-31481-855-741-4985


of treatment.




11/02/2020


PRODUCTION VIEW

PCP: PCP Phone: CareMore Health - Arizona


Issuer ID: 80840

Member ID:

Amerivantage Heart

CMS H1423-PBP: 003-000


Care Plus (HMO C-SNP)

RxID:

$0$35

$120$0

X634494900034


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-800-589-31481-855-741-4985


of treatment.




11/01/202011/05/2020


PRODUCTION VIEW

PCP:



Issuer ID: 80840

Member ID:

Amerivantage Classic Plus

CMS H1423-PBP: 004-000


(HMO)

RxID:

$0$35

$120$0

X634494900041


Customer Service:







1-888-816-2790711



1-888-291-13581-888-291-37581-800-589-31481-855-741-4985


of treatment.




11/01/202011/05/2020


PRODUCTION VIEW



Issuer ID: 80840

Member ID:

Amerivantage Smart Value

CMS H1423-PBP: 005-000


Plus (HMO)

RxID:

$10$40

$120$0

X634924500010


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-800-589-31481-855-741-4985


of treatment.



Processed DateExpected Mail DateActual Mail Date

2932864

11/02/2020


PCS PREVIEW

Intentionally Left Blank

PCP: PCP Phone: CareMore Health - Arizona


Issuer ID: 80840

Member ID:

Amerivantage CareMore Care

CMS H1423-PBP: 008-000

To You Plus (HMO I-SNP)


RxID:

$0$0

$120$0

X146864942400001


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-800-589-31481-855-741-4985


of treatment.


X146864942400001



Single Card PackageCard Front Card Back

PCS PREVIEW


PCP: T. GUPCP Phone: (

Rx BIN: 020115Rx PCN: IS

Rx GROUP: WM2AIssuer ID: 80840

Member ID:

Amerivantage Heart Care

CMS H2593-PBP: 013-000


(HMO C-SNP)

Rx ID:

$0$35$90

$0

Enhanced Dental and Vision Package

X36436864900001


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-800-446-00371-855-658-92491-855-741-4985

Providers:Dental:Vision:24/7 NurseLine:SilverSneakers:

of treatment.


Transportation: 1-844-923-0755

X36436864900001




PRODUCTION VIEW






PCP:



Issuer ID: 80840

Member ID

Amerivantage Classic (HMO)

CMS H2593-PBP: 001-000


RxID:

$0$35$90

$0

X634145400003


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-855-658-92491-855-741-4985


of treatment.


X634145400003



10/30/202011/03/2020


PRODUCTION VIEW



Issuer ID: 80840

Member ID:

Amerivantage Lung Care

CMS H2593-PBP: 005-000

(HMO C-SNP)


RxID:

$0$35$90

$0X634494000001


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-855-658-92491-855-741-49851-844-923-0755

Providers:Dental:24/7 NurseLine:SilverSneakers:Transportation:

of treatment.




10/31/202011/05/2020


PRODUCTION VIEW


PCP: -



Issuer ID: 80840

Member ID:

Amerivantage Diabetes

CMS H2593-PBP: 006-000

Care (HMO C-SNP)


RxID:

$0$35$90

$0

X634481800001


Customer Service:







1-833-337-1266711


TTY:Pharmacy Member Srvc:

1-888-816-2790

Help for Pharmacists: 1-833-377-42661-888-291-13581-888-700-09921-855-658-92491-855-741-49851-844-923-0755

Providers:Dental:24/7 NurseLine:SilverSneakers:Transportation:

of treatment.


X634481800001



10/31/202011/03/2020


PRODUCTION VIEW












































































PCP: PCP Phone:


Issuer ID: 80840

Member ID:

Amerivantage Smart Value

CMS H2593-PBP: 018-000


(HMO)

RxID:

$10$40

$120$0


X634481800038


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-800-446-00371-855-658-92491-855-741-4985


of treatment.


Transportation: 1-844-923-0755

X634481800038



2929820

10/31/202011/03/2020


PCS PREVIEW


PCP: M. MPCP Phone: (408)

Rx BIN: 020115Rx PCN: IS

Rx GROUP: WM2AIssuer ID: 80840

Member ID:

Amerivantage CareMore Care

CMS H2593-PBP: 019-000


To You (HMO I-SNP)

Rx ID:

$0$0

$120$0


X7030265000001


Customer Service:







1-888-816-2790711



1-888-291-13581-888-700-09921-800-446-00371-800-589-31481-855-741-4985


of treatment.


X7030265000001



10/05/2020


production view - amerigroup

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