Join the Care Team dedicated to helping beneficiaries with ESRD enjoy better health and committed to supporting your practice. DaVita VillageHealth's focus is the enrolled member. When talking to your patients about DaVita VillageHealth, please be sure to mention that they are entitled to all the benefits of Medicare, plus a variety of additional healthcare services and plan benefits, including:

• Access to a specially trained VillageHealth Nurse who is available round-the-clock, 7 days a week, to answer questions and provide assistance
• An ESRD disease management program and coordination of care
• Renal-friendly drug formulary with effective management and regular review of all patients' medications by a clinical pharmacist
• Information and education on treatment options and lifestyle choices that promote a better quality of life

These services and benefits also benefit you as a healthcare professional by providing you with the information and tools you need to successfully treat and monitor your patients who are member of DaVita VillageHealth.

Tools and Resources

To learn more about DaVita VillageHealth's benefit plans, claims administration practices, and many other topics important to you as a provider, click here to view or download our Provider Manual.

Or contact a Provider Relations Representative at 1-866-692-8760.

DaVita VillageHealth's prescription drug plan is administered by RxAmerica. To search our Formulary to determine whether a specific prescription drug is included, click here.

To find out if your patient's pharmacy is a member of DaVita VillageHealth's Pharmacy Network, click here.

Eligibility Information

DaVita VillageHealth is a Medicare Advantage Special Needs Plan with a Medicare Contract. Beneficiaries are eligible to enroll if:

• They are entitled to Medicare Part A and enrolled in Medicare Part B
• They have end stage renal disease (ESRD)
• The beneficiary resides in one of the service areas served by DaVita VillageHealth

Coverage Information

DaVita VillageHealth provides all the benefits of Original Medicare plus the prescription drug benefits of Medicare Part D and additional services designed specifically for ESRD beneficiaries.

To find out more about covered services, click here to view or download our Provider Manual.

The Summary of Benefits provides an outline of the benefits offered by DaVita VillageHealth. The content is provided in a standard format to allow for easy comparison of benefits with other Medicare Advantage plans.

View or download a copy of the Summary of Benefits

The Evidence of Coverage provides detailed information on covered benefits, cost sharing amounts, how to file a complaint or grievance, and many other important aspects of the DaVita VillageHealth plan.

View or download a copy of the Evidence of Coverage

Plan Determinations & Appeals

All Medicare beneficiaries have the right to request a coverage determination under Medicare Part D guidelines. Coverage determinations may be used to facilitate:

• Decisions to provide payment for a drug that is not on the Formulary
• Obtain prior authorization for a particular drug or drug regimen
• A decision whether a prescribed drug is medically necessary, appropriate or to be used for an FDA-approved indication
• A request for an exception. An exception is a coverage determination that involves a request to cover a drug not on our Formulary, waiving restrictions or limits such as dose limits, or changing the cost sharing amount paid by the member. You, as the physician, must request the exception.

Frequently, these decisions are made when a prescription is brought to the pharmacy by the member. The pharmacist will contact you to discuss or modify a prescription.

However, you, as the prescribing physician, may request an exception to the formulary, a quantity limit, or other coverage determination on behalf of a Medicare enrollee.

To request a coverage determination, you may use the Medicare Part D Coverage Determination Request. Click here to view or download a copy of this form.

You can expect a response to your request within 72 hours. If an expedited determination is requested, the decision will be made as soon as possible, but no later than 24 hours from the time the request is made.

For prescription drug coverage determinations (such as prior authorizations), inquiries, or a status update on a coverage request, contact us at:

• 1-866-838-1962
• 8:00 a.m. to 8:00 p.m.
• 7 days a week
• TTY users may dial 711

For Pharmacies Only:

• 1-866-873-6166