Maine.gov
Provider Help Desk: (p) 888-420-9711 (f) 800-408-1088 | Member Help Desk: (p) 866-796-2463 (f) 207-287-8601
Prior Authorization (PA) Helpdesk (for Provider PA inquiries): (p) 888-445-0497 (f) 888-879-6938

Medicare Part D Forms

Name Description Date
Medicare Part D Supplemental Form 40.73 KB 2011/04/28
Part B/D Combo Claim Form 90 KB 2008/10/20