On this page you’ll find important forms you can use to request coverage exceptions, reimbursements, and more.
Other Important Forms
CCA Rhode Island – Prescription Drug Coverage Determination Request Form
CCA Senior Care Options – Request for Redetermination of Medicare Prescription Drug Denial
Release of Information (ROI) Form
This form is used to release your health information from CCA to a person or organization. It can also be used to request your health information from a person or organization, such as a healthcare provider or hospital, to be shared with CCA.
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