Get the free BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form
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This document is a prior approval form for the use of Tykerb® (lapatinib) for patients with certain types of breast cancer, requiring specific information and confirmations from the prescriber.
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How to fill out bcbsvttvhp tykerb lapatinib prior
How to fill out BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form
01
Obtain the BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form from the official website or your healthcare provider.
02
Fill in the patient's personal information, including name, date of birth, and insurance details.
03
Provide the prescribing physician's information, including name, contact number, and NPI number.
04
Indicate the diagnosis for which Tykerb is being prescribed, ensuring it matches the medically necessary criteria.
05
List all previous therapies tried and any relevant medical history.
06
Detail the specific dosage and duration of Tykerb therapy as recommended by the physician.
07
Include any supporting documentation or clinical notes that justify the need for Tykerb.
08
Review the completed form for accuracy and completeness.
09
Submit the form to the appropriate BCBSVT/TVHP claims department via the specified method (fax, mail, or online).
10
Follow up with the insurance provider to confirm receipt and check the status of the approval.
Who needs BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form?
01
Patients diagnosed with conditions requiring Tykerb (lapatinib) treatment.
02
Healthcare providers prescribing Tykerb and needing prior approval from BCBSVT/TVHP.
03
Pharmacists who require confirmation of prior approval before dispensing the medication.
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People Also Ask about
What is the phone number for prior authorization for BCBS of California?
Phone: (800) 541-6652 7 a.m. to 5 p.m. PT, Monday through Friday, 8 a.m. to 5 p.m. PT, Saturday and Sunday.
What is the phone number for Medicaid prior authorization in Vermont?
Refer to the Fee Schedule for information on the code coverage and if the code requires a prior authorization. Questions about this policy can be directed to the DVHA Clinical Operations Unit at 802-879-5903.
Where is BCBS office in Vermont?
Our Office Location and Mailing Address We are located at 445 Industrial Lane, Berlin, Vermont.
What is the fax number for prior authorization BCBS of Vermont?
Submit pre-notification requests electronically via the Prior Authorization Portal by logging in to the Provider Resource Center. Download the prior approval form; fax the completed prior approval form(s) to (866) 387-7914.
What is the phone number for BCBS of Vermont prior authorization?
Download the prior approval form; fax the completed prior approval form(s) to (866) 387-7914. Call us directly for a pre-notification request. If calling, have the member name and certificate number ready, as well as the clinical details. Call us at (800) 922-8778.
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What is BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form?
The BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form is a document that healthcare providers must complete to obtain authorization from Blue Cross Blue Shield of Vermont (BCBSVT) or The Vermont Health Plan (TVHP) before prescribing Tykerb (lapatinib) to ensure it meets the necessary medical criteria.
Who is required to file BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form?
Healthcare providers who intend to prescribe Tykerb (lapatinib) for their patients are required to file the BCBSVT/TVHP Tykerb Prior Approval Form to secure prior authorization from the insurance provider.
How to fill out BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form?
To fill out the BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form, healthcare providers must provide pertinent patient information, including diagnosis, treatment history, and intended use of Tykerb, as well as sign the form to certify the information is accurate.
What is the purpose of BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form?
The purpose of the BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form is to establish medical necessity and ensure that the treatment is appropriate for the patient according to the guidelines set by the insurance provider.
What information must be reported on BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form?
The information that must be reported on the BCBSVT/TVHP Tykerb (lapatinib) Prior Approval Form includes patient details, medical diagnosis, previous therapies attempted, rationale for prescribed treatment, and any other relevant clinical information that supports the request for prior authorization.
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