Skip to Main Content

Special Supplemental Benefits for Chronically Ill Attestation

Effective January 1, 2023, the process to determine eligibly and attestation requirement will change from a fax to an online system through

Members are required to schedule an office visit with their provider for evaluation. Once appointment is made follow the steps below:

  1. Visit
  2. Follow the steps on to evaluate your patient against the eligibility requirements outlined on
  3. Submit an attestation form through indicating your patient meets the eligibility requirements.
  4. Submit a claim containing the appropriate diagnosis codes from this office visit indicating a member has been diagnosed with one or more qualifying chronic conditions listed on
  5. Upon receipt of all required information, the member will be sent an approval or denial letter within 10 business days. Approval letters include information on steps the member should follow to activate supplemental member benefits.
Last Updated: 11/08/2022