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UnitedHealthcare Community Plan PRIOR AUTHORIZATION REQUEST FORM Today's Date: URGENT: Yes QUEST Phone: 1-877-512-9357 DEXA Phone: 1-888-980-8728 Fax to: 1-800-267-8328 No MEMBER INFORMATION Please
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How to fill out prior authorization request
How to fill out a prior authorization request:
01
Start by gathering all the necessary information. This may include the patient's name, date of birth, insurance information, and the medication or procedure needing prior authorization.
02
Contact the patient's healthcare provider or pharmacist to obtain the appropriate form for the prior authorization request. This may vary depending on the insurance company.
03
Carefully review and fill out the form, making sure to provide accurate and detailed information. Be sure to include the patient's medical history, any supporting documentation, and the reason for the request.
04
If applicable, attach any relevant medical records, test results, or physician notes that support the need for the medication or procedure.
05
Double-check the form for completeness and accuracy. Ensure that all required fields are filled in and all necessary signatures are obtained.
06
Submit the prior authorization request to the appropriate department or contact at the insurance company. This may be done online, via fax, or through mail depending on the insurance company's preferred method.
07
Keep a copy of the prior authorization request form and any accompanying documentation for your records. This can be useful for future reference or in case of any disputes.
Who needs a prior authorization request?
01
Patients who are prescribed medications or procedures that require prior authorization from their insurance company.
02
Healthcare providers who want to ensure the medication or procedure is covered by the patient's insurance before proceeding.
03
Pharmacists who need prior authorization for certain medications before dispensing them to patients.
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What is prior authorization request?
Prior authorization request is a process used by insurance companies to determine if they will cover a prescribed medication or medical procedure.
Who is required to file prior authorization request?
Healthcare providers are required to file prior authorization requests with insurance companies.
How to fill out prior authorization request?
The prior authorization request form should be completed with all necessary patient information, medical history, and supporting documentation.
What is the purpose of prior authorization request?
The purpose of prior authorization request is to ensure that the prescribed medication or medical procedure is medically necessary and cost-effective.
What information must be reported on prior authorization request?
The prior authorization request should include patient demographics, medical history, provider information, and the reason for the requested medication or procedure.
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