Solutions 

Submission Agreement for E1 Non-Mapping

Part A/B

If you do not have switching service with RelayHealth, then contact your vendor or switch.

If you have an agreement with RelayHealth for switching services, you must submit a new amendment for the Eligibility services. The Facilitator has a standard contract that enables the pharmacy and Facilitator to participate in these services.

If you currently have switching service with RelayHealth and you are a Chain, Vendor, or Independent then, follow the directions below to submit a new agreement.

Part A/B Eligibility Facilitation Service Amendment Submission

  1. Print and complete the Medicare eligibility amendments Part A and B implementation form in its entirety, either on-line or by hand.
  2. Print and sign two copies of the Part A and B eligibility facilitation service amendment.
  3. Mail all three documents to our Legal Department at:
    RelayHealth
    Attn: Legal Department
    1564 Northeast Expressway NE
    Atlanta, GA 30329

Both Part A/B Eligibility Services Amendments must have a handwritten signature.
If you have any questions or need additional information, please contact our Customer Support Center at 1-800-388-2316.

Part D

If you do not have switching service with RelayHealth, then contact your vendor or switch.

If you have an agreement with RelayHealth for switching services, you must submit a new amendment for the Eligibility services. The Facilitator has a standard contract that enables the pharmacy and Facilitator to participate in these services.

If you currently have switching service with RelayHealth and you are a Chain, Vendor, or Independent then, follow the directions below to submit a new agreement.

Part D Eligibility Facilitation Service Amendment Submission

  1. Print and complete the Medicare eligibility amendments Part D implementation form in its entirety, either on-line or by hand.
  2. Print and sign two copies of the Part D eligibility facilitation service amendment.
  3. Mail all three documents to our Legal Department at:
    RelayHealth
    Attn: Legal Department
    1564 Northeast Expressway NE
    Atlanta, GA 30329

Both of the Part D Eligibility Services Amendments must have a handwritten signature.

If you have any questions or need additional information, please contact our Customer Support Center at 1-800-388-2316.

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