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ANTIDEPRESSANT PRIOR AUTHORIZATION FORM Fax Completed Form to: 866-254-0761 SD DEPARTMENT OF SOCIAL SERVICES MEDICAL SERVICES DIVISION For questions regarding this Prior authorization, call 866-705-5391
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What is antidepressant prior authorization form?
The antidepressant prior authorization form is a document that must be completed and submitted to a healthcare provider or insurance company to request approval for coverage of antidepressant medications.
Who is required to file antidepressant prior authorization form?
The individuals required to file an antidepressant prior authorization form are those who are seeking coverage for antidepressant medications through their healthcare provider or insurance company.
How to fill out antidepressant prior authorization form?
The antidepressant prior authorization form should be filled out by providing the requested personal information, such as name, date of birth, contact information, as well as details about the prescribed medication and the medical necessity for its use.
What is the purpose of antidepressant prior authorization form?
The purpose of the antidepressant prior authorization form is to determine whether the requested antidepressant medication is medically necessary and eligible for coverage under the individual's healthcare plan.
What information must be reported on antidepressant prior authorization form?
The antidepressant prior authorization form typically requires information such as the patient's personal details, the prescribing healthcare provider's information, the specific antidepressant medication being requested, the dosage, and the medical justification for the prescription.
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