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Schedule MTM

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Login Help Form

If you are having issues retrieving your username, resetting your password, or logging into the website in general, please fill out the form below.  We...

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Fall Prevention Care Kit Request Form

To request a Fall Prevention Care Kit, please answer the questions below, and a kit will be mailed to your home address in 3 to 4 weeks. Be sure to answer...

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Member ID Card Request Form

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Appeals Grievances and Exceptions Report

SCAN Member Requests As a member of our plan you may ask a question, request a replacement member identification card, request member materials or change...

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I Have a Question

SCAN Member Requests As a member of our plan you may ask a question, request a replacement member identification card, request member materials or change...

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Request for Redetermination of Medicare Prescription Drug Denial

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Download Medicare Prescription Drug Coverage Determination

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Benefit Program Reimbursement Forms

Find a Benefit Program Reimbursement Form

Web Page

Claims and Reimbursement Request Forms

Find a claim forms in English and in Spanish

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