Get the free aetna prolia prior authorization form

(?, ?) Injectable Medication Recertification Request (All fields must be completed and legible for recertification review) Aetna Recertification Notification 503 Support Lane, Orlando, FL 32809 Phone:

How to fill out prolia order form pdf

How to fill out Aetna Prolia auth form:

1. Provide your personal information, such as your name, address, phone number, and date of birth.
2. Include your Aetna insurance policy information, including your policy number and group number.
3. Indicate the healthcare provider who is requesting the authorization for Prolia treatment.
4. Provide the healthcare provider's information, including their name, address, and phone number.
5. Describe the medical condition or reason for requesting Prolia treatment.
6. Include any relevant medical history or previous treatments related to the condition.
7. Attach any supporting documents, such as medical records or test results, to substantiate the need for Prolia treatment.
8. Sign and date the form, confirming that all the information provided is accurate and true.
9. Submit the completed form to the appropriate Aetna department or office.

Who needs Aetna Prolia auth form:

1. Patients who are seeking Prolia treatment for a specific medical condition.
2. Healthcare providers who are prescribing Prolia and need to obtain authorization from Aetna.
3. Individuals covered under Aetna insurance who want to access Prolia medication as part of their healthcare treatment plan.

People Also Ask about

What is the difference between Xgeva and Prolia?

Xgeva vs Prolia While Xgeva is indicated for bone loss and calcium increase related to a malignant disease, like Multiple Myeloma, Prolia is indicated for bone loss related to osteoporosis and other diseases that cause hormonal dysregulations.

How do I bill Prolia?

When submitting the claim, remember to: Bill 60 units of J0897 with administration HCPCS 96372 (Therapeutic prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). J0897 is for 1 mL. Prolia is administered in a single-dose prefilled syringe of 60mg/mL.

Who can administer Prolia injection?

Denosumab injection comes as a solution (liquid) to be injected subcutaneously (under the skin) in your upper arm, upper thigh, or stomach area. It is usually injected by a doctor or nurse in a medical office or clinic. Denosumab injection (Prolia) is usually given once every 6 months.

Can Prolia be substituted for Xgeva?

Both drugs are used to help prevent bone fractures in people with certain cancers. But each drug is used to prevent bone fractures related to different kinds of cancer. Because Prolia and Xgeva are not used for the same cancers, your doctor isn't likely to have you switch from one drug to the other.

How often will Medicare pay for Prolia injections?

99% of Medicare Part D patients have access* to Prolia. The average out-of-pocket (OOP) cost for Prolia® through Medicare Part D is $115‡ every 6 months, which equals $19.16 per month.

Is Prolia and Xgeva the same?

Denosumab is also known by its brand names, Xgeva and Prolia. It helps to prevent fractures and other cancer related bone problems in adults with cancer that has spread to the bones. Prolia can reduce the risk of spinal fractures in men who have weakened bones due to hormone therapy for prostate cancer.

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What is aetna prolia auth form?

The Aetna Prolia auth form is a document required by Aetna for the authorization of Prolia, a medication used to treat osteoporosis in postmenopausal women and to prevent fractures in patients with certain bone conditions.

Who is required to file aetna prolia auth form?

Healthcare providers prescribing Prolia must file the Aetna Prolia auth form to obtain authorization for the medication on behalf of their patients.

How to fill out aetna prolia auth form?

To fill out the Aetna Prolia auth form, healthcare providers need to provide patient information, medication details, medical history, and any other relevant clinical information required by Aetna.

What is the purpose of aetna prolia auth form?

The purpose of the Aetna Prolia auth form is to ensure that the prescribed use of Prolia meets Aetna's criteria for medical necessity and to facilitate the approval process for coverage.

What information must be reported on aetna prolia auth form?

The Aetna Prolia auth form requires reporting of patient demographics, prescribing physician details, diagnosis codes, treatment history, and justification for the use of Prolia.