Skip navigation
SD Coverage Determinations Hero

Coverage Determinations and Redeterminations

This section is to assist you with coverage determinations and redeterminations for Senior Dimensions. Please make sure you or your provider complete all requested information and submit the forms as outlined below.

You may request a coverage determination by using one of the following methods:

  • You may request a coverage determination by logging on to OptumRx.com and completing a prior authorization request. You will need to log in to access the tool. If you are a new user with OptumRx, you will need to register before you can access the prior authorization request tool. Once you have registered, you will find the prior authorization tool under the Health Tools menu.
  • You may request a coverage determination by printing the Coverage Determination Form (Published on: October 1, 2016) and mailing it to OptumRx, M/S CA106-0286, 3515 Harbor Blvd., Costa Mesa, CA 92626.
  • You may request a coverage determination by printing the Coverage Determination Form (Published on: October 1, 2016) and faxing it to 1-800-527-0531.
  • You may request a coverage determination by calling toll-free 1-800-650-6232, TTY 711. Hours of operation are October 1 - February 14: 8 a.m. - 8 p.m. local time, 7 days a week. February 15 - September 30: 8 a.m. - 8 p.m. local time, Monday - Friday. On Saturday, Sunday and holidays, please leave a detailed message and a representative will return your call within one business day.
  • You may request a coverage determination by visiting the Centers for Medicare & Medicaid Services (CMS) website and use their determination form.

You may request a coverage redetermination by using one of the following methods:

  • You may request a coverage redetermination by secure email. Please click here.(Link coming soon)
  • You may request a coverage redetermination by printing the Coverage Redetermination Form (Published on: October 1, 2016) and mailing it to Senior Dimensions/Part D Appeals, P.O. Box 6106, CA 124-0197, Cypress, CA, 90630.
  • You may request a coverage redetermination by printing the Coverage Redetermination Form (Published on: October 1, 2016 and faxing it to 1-866-308-6294.
  • You may request a coverage redetermination by calling toll-free 1-800-650-6232, TTY 711. Hours of operation are: October 1 - February 14: 8 a.m. - 8 p.m. local time, 7 days a week. February 15 - September 30: 8 a.m. - 8 p.m. local time, Monday - Friday. On Saturday, Sunday and holidays, please leave a detailed message and a representative will return your call within one business day.
  • You can also review your Evidence of Coverage for more information. To access your Evidence of Coverage from this website click here.

If you have questions, need assistance in filling out a form, or would like to inquire about the status of a coverage determination or redetermination, you or your provider may call us toll-free 1-800-650-6232, TTY 711. Hours of operation are October 1 - February 14: 8 a.m. - 8 p.m. local time, 7 days a week. February 15 - September 30: 8 a.m. - 8 p.m. local time, Monday - Friday. On Saturday, Sunday and holidays, please leave a detailed message and a representative will return your call within one business day.

Find out how to appoint a representative.