missouricare ID card template

NO PRINT AREA
MO021479_CAD_IDC_ENG
©WellCare 2013 MO_02_13 State Approved 03082013
Here is your personal
Missouri Care identification card.
Para más información en español por favor llamar a este
número 1-800-322-6027.
<FIRST_NAME6> <MIDDLE_INIT7> <LAST_NAME8>
<ADDRESS_LINE19> <ADDRESS_LINE210>
<CITY11> <STATE12> <ZIP13>
NO PRINT AREA
THIS ID CARD IS NOT A GUARANTEE OF ELIGIBILITY, ENROLLMENT OR PAYMENT.
www.missouricare.com
PCP: <PHY_FIRST_NAME22> <PHY_LAST_NAME23>
PCP Phone: <PHY_PHONE31>
Effective Date: <EFFECTIVE_DATE33>
Member ID #: <SUBSCRIBER_ID4>
Date of Birth: <DOB14>
Member: <FIRST_NAME6> <MIDDLE_INIT7> <LAST_NAME8>
THIS ID CARD IS NOT A GUARANTEE OF ELIGIBILITY, ENROLLMENT OR PAYMENT.
www.missouricare.com
PCP: <PHY_FIRST_NAME22> <PHY_LAST_NAME23>
PCP Phone: <PHY_PHONE31>
Effective Date: <EFFECTIVE_DATE33>
Member ID #: <SUBSCRIBER_ID4>
Date of Birth: <DOB14>
Member: <FIRST_NAME6> <MIDDLE_INIT7> <LAST_NAME8>
51283
P.O. Box 31365
Tampa, FL 33631-3365
NO PRINT AREA
�
MEMBERS: In an emergency, call 911 or go to the nearest hospital. For non-emergency
care, always call your PCP. Benefits may be limited based on your eligibility group.
Member Services:
1-800-322-6027
Behavioral Health Crisis Line: 1-800-322-6027
Transportation:
1-800-322-6027
Behavioral Health Services:
1-800-322-6027
Language Line:
1-800-322-6027
Pharmacy Services:
1-800-392-2161
or 573-751-6527
TTY MO Relay 711: 1-800-735-2966
24-Hour Nurse Line: 1-800-919-8807
Dental Services:
1-800-322-6027
Vision Services:
Care Management:
1-800-322-6027
1-800-322-6027
Si no habla ingles llamé al 1-800-322-6027 para ayuda.
PROVIDERS: Prior authorization, call 1-800-322-6027. Details: www.missouricare.com.
SEND MEDICAL CLAIMS TO:
Missouri Care Claims Submission
P.O. Box 31224
Tampa, FL 33631-3224
REPORT FRAUD AND ABUSE ISSUES:
1-866-678-8355
MOC13041 Approved 03082013
MEMBERS: In an emergency, call 911 or go to the nearest hospital. For non-emergency
care, always call your PCP. Benefits may be limited based on your eligibility group.
Member Services:
1-800-322-6027
Behavioral Health Crisis Line: 1-800-322-6027
Transportation:
1-800-322-6027
Behavioral Health Services:
1-800-322-6027
Language Line:
1-800-322-6027
Pharmacy Services:
1-800-392-2161
or 573-751-6527
TTY MO Relay 711: 1-800-735-2966
24-Hour Nurse Line: 1-800-919-8807
Dental Services:
1-800-322-6027
Vision Services:
Care Management:
1-800-322-6027
1-800-322-6027
Si no habla ingles llamé al 1-800-322-6027 para ayuda.
PROVIDERS: Prior authorization, call 1-800-322-6027. Details: www.missouricare.com.
SEND MEDICAL CLAIMS TO:
Missouri Care Claims Submission
P.O. Box 31224
Tampa, FL 33631-3224
REPORT FRAUD AND ABUSE ISSUES:
1-866-678-8355
MOC13041 Approved 03082013
NO PRINT AREA