We Love Working with You to Fix the System

Pharmacy providers are the backbone of our claims management process. We are committed to providing you with the resources and information you need to process pharmacy claims quickly and efficiently.

Prior Authorization Request Form – Fertility

Fax to 800.476.2691 for review.

Pharmacy MAC Pricing Appeals

For generic reimbursement concerns, click here for more information.

MAC Request Form

Use this form to request IPM’s MAC List.

Pharmacy Provider Manual

Check out our manual for general terms, conditions, procedures, and policies.

Payor Sheet

Access payor sheets for the latest requirements to submit claims electronically.

Prior Authorization Appeal Form

To appeal a prior authorization denial, use this form.

Prior Authorization Request Form

Fax to 800.476.2691 for review.

Tennessee Wholesaler Submission

Click here for more information about Tennessee wholesale and manufacturer information collection and to download our form.

Workers' Compensation Payor Sheet

Access payor sheet for the latest requirements to submit claims electronically.