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DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F00556 (01/12) STATE OF WISCONSIN DHS 107.10(2), Wis. Admin. Code FORWARDHEALTH PRIOR AUTHORIZATION DRUG ATTACHMENT

How to fill out prior authorization drug attachment

How to fill out a prior authorization drug attachment:

1. Begin by gathering all the necessary information. This includes the patient's personal details, insurance information, and the specific drug being requested for prior authorization.
2. Fill out the patient's personal information section accurately and completely. This will typically include their name, date of birth, address, and contact information. Ensure that all information is up to date and matches their insurance records.
3. Next, provide the insurance information requested. This may include the name of the insurance provider, the patient's policy number, and any other required details. Double-check this information to eliminate any mistakes or typos that could potentially lead to delays or denials.
4. Identify the specific drug that requires prior authorization. Include the drug's name, dosage, and any other relevant information such as frequency or duration of use. It's important to be precise and include all necessary details to avoid confusion.
5. Additionally, you will need to provide the reason for the medication request. This might involve explaining why the prescribed drug is essential for the patient's treatment, why alternative medications are not suitable, or supporting evidence such as medical records or test results.
6. Attach any supporting documents or evidence that may be required. This could include the patient's medical history, test results, physician's notes, or any other relevant documentation that supports the need for the requested drug.
7. Review the completed prior authorization drug attachment form thoroughly. Make sure all sections are filled out accurately, legibly, and in a timely manner. Double-check for any missing information or errors that could potentially lead to delays or rejections.

Who needs prior authorization drug attachment?

1. Patients who are prescribed medications that require prior authorization from their insurance provider need to complete a prior authorization drug attachment form.
2. The need for prior authorization varies depending on the individual's insurance plan and the specific medication being requested. Some insurance plans may require prior authorization for certain high-cost drugs or medications that have alternatives available.
3. It is crucial to consult with the healthcare provider or the insurance company to determine whether a prior authorization drug attachment is necessary. They can provide guidance on the specific requirements and assist in obtaining the necessary approvals.

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What is prior authorization drug attachment?

Prior authorization drug attachment is a form required by insurance companies to approve coverage for certain prescription drugs before they can be dispensed to the patient.

Who is required to file prior authorization drug attachment?

Healthcare providers, pharmacists, or patients may be required to file prior authorization drug attachment depending on the insurance company's policy.

How to fill out prior authorization drug attachment?

Prior authorization drug attachment can be filled out by providing the necessary patient and drug information as requested on the form.

What is the purpose of prior authorization drug attachment?

The purpose of prior authorization drug attachment is to ensure that the prescribed medication is appropriate, medically necessary, and covered by the patient's insurance plan.

What information must be reported on prior authorization drug attachment?

Information such as patient demographics, healthcare provider information, drug name, dosage, frequency, and diagnosis may need to be reported on the prior authorization drug attachment.