\r\n Communication Policy\r\n
\r\n\r\n Privacy Policy\r\n
\r\n\r\n Communication Policy\r\n
\r\n\r\n Privacy Policy\r\n
\r\n\r\n {text && text}\r\n {links?.map((link) => {\r\n if (link.relative) {\r\n return (\r\n
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\r\n {!dateSelected ? '' : `(Time Zone: ${timeZone})`}\r\n
\r\n {availableFilteredTimes.length === 0 && dateSelected\r\n ? 'No appointments are available on this date at this time. Please select a different date or time.'\r\n : availableFilteredTimes.map((x) => (\r\n\r\n Thank you for registering for Tria Health’s Patient Portal. You’ll now have access to a variety or resources that can help you both manage and\r\n improve your health.\r\n
\r\n\r\n A designated member advocate will send you an appointment time according to the preferences you shared earlier. You should receive this\r\n email in the next 24-48 hours.\r\n
\r\n\r\n Once you receive the email, you will be asked to complete the following steps prior to your scheduled appointment. We look\r\n forward to meeting with you!\r\n
\r\n >\r\n ) : (\r\n <>\r\n\r\n Your appointment has been booked! Finish creating your Tria Health portal account and complete your{' '}\r\n required patient intake form prior to your initial appointment.\r\n
\r\n ) : (\r\nPlease check the ONE best answer for your abilities at this time.
\r\nBase your answers on how you felt yesterday.
\r\nPlease check the ONE best answer for your abilities at this time.
\r\nPlease check the ONE best answer for your abilities at this time.
\r\n\r\n All information must be provided in order to accurately process your claim(s). Incomplete or illegible information will result in form\r\n being returned or payment delays.\r\n
{' '}\r\n\r\n PLEASE ALLOW TWO - FOUR (2-4) WEEKS FOR PROCESSING\r\n
{' '}\r\n\r\n Being able to submit manual claims to Tria Health for potential reimbursement is part of your prescription benefit package. In\r\n situations where the pharmacy cannot or will not process your Tria Health incentive, we are happy to process those claims manually based\r\n on the guidelines of your plan design.\r\n
{' '}\r\n\r\n The amount of reimbursement received may be less than the member paid at the pharmacy based on a number of variables including plan\r\n design, deductibles, co-payments, and discounted price of drug.\r\n
{' '}\r\n\r\n Reimbursements cannot be processed if the prescription fill date is greater than 12 months from the time the reimbursement is submitted.\r\n
{' '}\r\n\r\n If you need assistance completing this form or have questions regarding this reimbursement process, a Tria Health Member Advocate can be\r\n reached at {PhoneNumberPeriodDelimited}.\r\n
\r\n\r\n Member Name: Enter the person for whom the prescription was written. This is either the\r\n cardholder, the spouse of the cardholder, or a dependent of the cardholder.\r\n
\r\n\r\n Date of Birth: Enter the birth date of person for whom the prescription was written.\r\n
\r\n\r\n Tria ID Number: Enter the member Identification Number assigned to you by Tria Health.\r\n
\r\n\r\n Address: Enter permanent mailing address.\r\n
\r\n\r\n Contact info: Provide e-mail address and daytime phone number.\r\n
\r\n\r\n Please indicate the total number of individual prescriptions you are submitting for reimbursement. This number should be the same number\r\n of attached receipts and/or line items on a printout.\r\n
\r\n\r\n Most Pharmacies supply a receipt for each individual prescription which includes the required information. If you have lost a receipt,\r\n or have multiple claims, the Pharmacy can supply you with a printout of prescriptions for a given time period. Either the receipt or the\r\n printout will be sufficient if it provides the following information:\r\n
\r\nCash register receipts do NOT have the information required to process a claim.
\r\n\r\n If you had to pay out of pocket for a claim you feel should have been covered by the Tria Health Incentive, please submit a\r\n Reimbursement Form for approval and processing. All information must be provided in order to accurately process your claim(s).\r\n Incomplete information will result in form being returned or payments delays.\r\n
\r\nPlease allow 2-4 weeks for processing
\r\nIf you have questions, please contact the Tria Help Desk:
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