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A form required for prior authorization of Synagis medication for eligible recipients in the Maryland Medicaid Pharmacy Program, including recipient information, dosing calculations, and required
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How to fill out synagis service prior-authorization
How to fill out SYNAGIS SERVICE PRIOR-AUTHORIZATION
01
Gather necessary patient information including demographic details, insurance information, and clinical history.
02
Obtain a prescription from a healthcare provider for SYNAGIS.
03
Fill out the prior authorization form provided by the insurance company, ensuring all required fields are completed.
04
Attach any relevant medical documentation, such as lab results or clinical notes that support the need for SYNAGIS.
05
Submit the prior authorization request to the insurance company, either online or via fax, according to their submission guidelines.
06
Monitor the status of the prior authorization request and be prepared to provide additional information if requested by the insurance company.
Who needs SYNAGIS SERVICE PRIOR-AUTHORIZATION?
01
Infants and young children who are at high risk for severe respiratory syncytial virus (RSV) infection.
02
Patients with certain medical conditions, such as bronchopulmonary dysplasia or congenital heart disease, that increase the risk of RSV.
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People Also Ask about
How much does the Synagis shot cost?
The cost for Synagis (100 mg/mL) intramuscular solution is around $1,954 for a supply of 0.5 milliliters, depending on the pharmacy you visit. Quoted prices are for cash-paying customers and are not valid with insurance plans.
What is the monthly shot for RSV?
The placebo and SYNAGIS groups did not show statistically significant differences in incidence of RSV-related ICU admissions (3.7% vs 2.0%, P=0.094), total days of RSV-related ICU stays per 100 children (71.2 days vs 15.9 days, P=0.80), incidence of RSV-related mechanical ventilation (2.2% vs 1.3%, P=0.282), or total
How do I get Synagis approved?
To obtain prior authorization for Synagis®, the prescriber or authorized agent must contact the clinical call center at 1-877-309-9493, follow the appropriate prompts and be prepared to provide justification for use outside of the American Academy of Pediatrics guidelines and FDA approved indications.
How many doses of RSV are there?
Each dose of SYNAGIS helps protect your child from severe RSV disease for about a month. SYNAGIS should be given to high-risk babies every 28-30 days during RSV season. Talk to your doctor about a dosing schedule appropriate for your area.
Is Synagis covered by insurance?
SYNAGIS® (palivizumab) may be covered under a patient's pharmacy or medical benefit. Sometimes SYNAGIS is covered under both benefits, or by more than 1 plan, depending on the patient's insurance. To ensure timely approval for SYNAGIS, collect all prescription and medical benefit information for appropriate patients.
How many doses of synagis are given?
The recommended dose of SYNAGIS® (palivizumab) is 15 mg/kg of body weight given monthly by IM injection. The first dose of SYNAGIS should be administered prior to commencement of the respiratory syncytial virus (RSV) season and the remaining doses should be administered monthly throughout the RSV season.
How many doses of Synagis are needed?
The recommended dose of Synagis is 15 mg per kg of body weight given monthly by intramuscular injection. The first dose of Synagis should be administered prior to commencement of the RSV season and the remaining doses should be administered monthly throughout the RSV season.
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What is SYNAGIS SERVICE PRIOR-AUTHORIZATION?
SYNAGIS SERVICE PRIOR-AUTHORIZATION is a process required by health insurance providers to obtain approval before administering SYNAGIS, a medication used to prevent respiratory syncytial virus (RSV) infections in infants and young children at high risk.
Who is required to file SYNAGIS SERVICE PRIOR-AUTHORIZATION?
Healthcare providers, such as pediatricians or specialists prescribing SYNAGIS, are required to file SYNAGIS SERVICE PRIOR-AUTHORIZATION to ensure that the treatment is covered by the patient's insurance plan.
How to fill out SYNAGIS SERVICE PRIOR-AUTHORIZATION?
To fill out SYNAGIS SERVICE PRIOR-AUTHORIZATION, a provider must complete the provided forms with patient details, clinical information supporting the need for SYNAGIS, and any relevant medical history. The forms typically require specific data regarding the patient's condition and risk factors.
What is the purpose of SYNAGIS SERVICE PRIOR-AUTHORIZATION?
The purpose of SYNAGIS SERVICE PRIOR-AUTHORIZATION is to ensure that the use of SYNAGIS is medically justified and that it meets the criteria set by insurance providers for coverage, thereby controlling costs and ensuring patient safety.
What information must be reported on SYNAGIS SERVICE PRIOR-AUTHORIZATION?
Information that must be reported includes the patient's demographic details, medical history, diagnoses, clinical justification for using SYNAGIS, treatment history, and any previous RSV-related complications.
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