Claims Processing Transition Effective 1/1/2024.
Quick Links
- Annual MOC Training
- Provider Manual
- Covered drugs list for HMO Members
- Covered drugs list for DSNP Members
- ONLINE Prior Authorization Form (Medical Coverage Determination Form)
- FAX - Prior Authorization Form (Medical Coverage Determination Form)
- Electronic Prescription Drug Coverage Determination Request (Prescription Prior Authorization)
- Electronic Prescription Drug Coverage Redetermination Request (Prescription Prior Authorization Appeal)
- Provider Dispute and Appeal Form
- Provider Dispute and Appeal Form (Fillable PDF)
- Waiver of Liability Form
- Waiver of Liability Form (Fillable PDF)
- Rules for Prior Authorizations
- Inpatient Readmission Updates (May 2023)
- Prior Authorization Codes Search
Join Our Network
Thank you for your interest in becoming a Troy Medicare network provider. Please click here to complete the Provider Contracting Form and we will send you the necessary information immediately.
We look forward to working with you to improve the health of members in the community. You can also email us at network@troymedicare.com
As a Troy Medicare provider, you will have access to:
- A comprehensive approach to care for your patients with meaningful collaboration with pharmacists and disease management programs
- Initial and ongoing provider education through orientation, office visits, and updates
- A dedicated claims team to ensure prompt and accurate payment
- No referral requirements and minimum prior authorizations
- A dedicated provider relations team to keep you informed
- An online Secure Provider Web portal where you can check member eligibility
Secure Provider Web Portal
For claims with a date of service prior to 01/01/2024:
If you are a contracted Troy Medicare provider, you can register by following these instructions. If you are a non-contracted provider, you will be able to register after you submit your first claim. Once you have created an account, you can use the Troy Medicare Care provider portal to:
- Verify member eligibility
- Verify Claim Status
- View Payment History
For claims with a date of service after 01/01/2024:
If you are a contracted Troy Medicare provider, you can register by emailing the provider request form to network@Troymedicare.com. If you are a non-contracted provider, you will be able to register after you submit your first claim. Once you have created an account, you can use: https://provider.troymedicare.com/
- Verify member eligibility
- Verify Claim Status
- View Payment History
Provider Resources
Troy Medicare provides the tools and support you need to deliver the best quality of care.
View our listing of available resources below, that covers forms, guidelines, helpful links, and training.
- Manuals, Forms and Resources
- Eligibility Verification
- Electronic transactions
- Covered drugs list
- Provider Training
- Provider welcome reference guide