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Fax Application Cover Sheets

• Please Fax One App at a time
• Please write the tracking number which is found on the bottom of the application (in red) in the remarks section of the fax cover sheet (below).  Due to the red ink on the application, the tracking number does not always transmit clearly on the fax copy.
• Hold onto your Fax Confirmations
• Fax Cover Sheets (PLEASE USE THESE)
  • Fax Coversheet for CCP - All Local HMO/PPO Advantra plans (Fax Numbers for all of the Local Plans are on Page 2!!)
  • Fax Coversheet for PDP's (PDP) - Advantra RX

Enrollment of Coventry PFFS Members Losing Coverage in CCP Areas

• Coventry will be launching a dedicated Telephonic Enrollment hotline which is to be exclusively used for Coventry PFFS members who are losing their coverage and who reside in a Coordinated Care Plan Service Area.
• To participate in this program, you must be "Ready to Sell", meaning you have completed the AHIP certification and CCP certification, you are appointed and licensed in the appropriate state.
• Coventry will be reaching out to these members in accordance with CMS guidelines.
• If you are the agent of record and "Ready to Sell", Coventry will make every effort to "Match back" the commission to you as the original writing agent.  (Where no agent was involved in the process.)
• If another agent enrolls a current PFFS member into a CCP plan, the NEW agent will be credited with the commission.
• These Numbers are EXCLUSIVELY to be used for PFFS members (not general enrollment)
  • Altius - 888-486-9832
  • Georgia - 888-248-8089
  • Group Health Plan (GHP) - 888-248-8089
  • Health America (Central PA) - 888-248-8049
  • Health America (Western PA) - 888-401-8093
  • Iowa - 888-248-8098
  • Kansas - 888-248-8106
  • Nebraska - 888-467-4320
  • PersonalCare - 888-467-4413
  • Summit (South Florida) - 888-467-4416
  • Summit (Tampa) - 888-467-4420
  • Texas - 888-541-2763
  • Vista - 866-608-8051
  • Vista (South Florida) - 866-608-8054
  • WellPath - 888-401-8090

Critical Info

• The app MUST BE RECEIVED by Coventry (this is a CMS rule) within 48 hours of the dates it is signed by the Agent.  Thus, we recommend faxing or over-nighting enrollments.
• Please be aware that new CMS rules require phone verification.  View the "What Happens Next" document to learn more about the process.
• The Scope of Appointment form is not currently required to be submitted with the app.  However, you are responsible to maintain evidence of prior approval for any appointments for 10 years.  This could be a recording of a telephone conversation or a Scope of Appointment form.
• All Enrollment applications (paper and electronic) must contain the appropriate Agent Writing Number (AWN) issued by Coventry in order to be eligible to receive commission payments for 2010.
• • If you don't have your AWN, call the Broker Service Unit (See our Contact Page for the BSU number)
• During AEP (November 15th - December 31st) DO NOT submit the Enrollment Checklist.  Doing so will delay the application!  This is ONLY used during AEP if your are using a known SEP during the AEP timeframe (unlikely!)
• For compliance purposes, if you are unsure of any of the CMS Marketing regulations, review Coventry's Sales Presentation Checklist.

Electronic Submission

• View an Online Demo of the Electronic Submission Process.

• You can now submit Coventry CCP plans and Prescription drug plans. 

• Online enrollment can only be submitted in person your client must click the “Submit” button. 

• Be sure not to skip any of the required fields on the web application. 

• Before starting the online enrollment you must read all the terms and conditions and answer any questions your client might have. 

• If you do not enter your Agent Writing Number you will NOT be paid on the application. 

• Once the application is completed you will be giving a confirmation number be sure to keep this number it is your Application Tracking number. 

• You will also want to give this number to the client in case they need to reference any questions about there policy. 

• Below are the links to the online enrollment sites and the phone number for help:

  • Advantra Coordinated Care Plans   Use the Phone number on the enrollment application.

  • AdvantraRX Part D   800-882-3822 

Overnight Mail

• You must mail to the Street Address indicated in the Instructions of the Enrollment form.  Do not send Overnight Mail to a PO Box address, it will not be accepted!

Submitting Business with Coventry Telephonically

• For Complete Guide, Go to the Resource Center and select "Agent Guide" and "Coventry" and click submit or View an Online Demo.
• Telephonic Enrollment is available for: Part D (Advantra RX) and Advantra (HMO/PPO)
  • Once the presentation is complete and the beneficiary or the authorized representative agrees to enroll in one of Coventry’s products.
  • Hours are 8am to 8pm (Local Time), 7 days a week.

1. The agent may call the dedicated telephonic enrollment line: 1-866-520-4959.
2. Have your Agent Writing Number (AWN) available for the operator
3. The call will be answered by an IVR which greets the caller and advises that the call may be monitored or recorded  The caller will have two (2) choices:  Press 1 if you are calling from TX, CA,  FL, AL or GA.  All other callers press 2.
4. Once the caller makes their selection, the call is routed to the appropriate telephone enrollment representative.
5. If there will be more than one enrollment during this telephone call, tell the representative at the beginning of the call.
6. The agent, beneficiary or authorized representative may give the member information to the representative.
7. You can select EFT as the payment option, but the Operator will NOT take Bank Information over the phone.  They will be mailed the EFT information to be set up.
8. If the agent is giving the member information to the telephone representative, after receiving all the member information, the representative will ask to speak to the member.
9. The representative will ask permission to record the conversation.
10. The representative will ask the member for their first and last names as they appear on their Medicare Card.  They will then read the terms and conditions of enrollment.  It is vitally important that the member understand the terms and conditions of enrollment prior to making the telephonic call because the representative must receive an affirmative "YES" response indicating that the member understands.
11. When the member acknowledges that they understand, the representative will thank the caller and end the call.  In the case of a second enrollment on the same call, if the representative was informed at the beginning of the call that there will be multiply enrollments, the representative will ask to speak to the next beneficiary, the agent, or the authorized representative.
12. IMPORTANT:  Upon completing the telephone enrollment, the telephone representative will provide the beneficiary or authorized representative with the Application Tracking Number (ATN) to document the enrollment.  Please prepare the beneficiary or authorized representative to write the number down.

• The telephone representative is to gather the information necessary to complete the enrollment application.  The representative is allowed to provide general benefit information only. 
  • The representative is NOT ALLOWED TO:
    • Discuss features or benefits of the plan
    • Answer any questions about the plan
    • Compare one plan to other plans available
    • Speak with anyone other than the beneficiary or authorized representative during the recorded portion of the call.  

Summitting Stand Alone Prescription Drug Business (PDP)

• If someone is on a non renewal plan, and you are submitting a new application for them, please make sure that you include the effective date for the new plan on the top of the application.
  • PLAN CHANGE FORM
• NOTE:  IF YOU ARE SELLIING ADVANTRA RX THROUGH ANOTHER PARTNER, YOU MUST SUBMIT BUSINESS TO THIS NUMBER.  FOLLOW THE INSTRUCTIONS OF THE OTHER PARTNER FOR SUBMISSION.
• Important Information regarding paper applications taken through the mail: 
  • Applications can now be sold via the mail as long as the consumer is educated over the phone and full disclosure of all required info is provided. 
  • You still need to mail the entire application package.

Submitting HMO/PPO Business in Central PA (PACE/PACENET)

• If you are enrolling someone in Advantra who has PACE or PACEnet, be sure that the Medicare beneficiary calls PACE to let them know that they are enrolling in Advantra, otherwise, PACE could auto enroll them in a Partner PDP plan and disenroll them from Advantra.  See my blog on this topic.