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Zelig Prior Authorization Request (For Maryland Only) Send completed form to: Case Review Unit CVS/earmark Specialty Programs Fax: 8662496155 CVS/earmark administers the prescription benefit plan
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How to fill out prior authorization request
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To fill out a prior authorization request, follow these steps:
Who needs prior authorization request?
01
Prior authorization requests are needed by healthcare providers, including doctors, nurses, and pharmacists, who want to prescribe or provide certain medications, procedures, or services that require approval from the patient's insurance company.
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What is prior authorization request?
Prior authorization request is a process where healthcare providers request approval from an insurance company before certain medications, treatments, or procedures can be covered.
Who is required to file prior authorization request?
Healthcare providers and facilities are typically required to file prior authorization requests.
How to fill out prior authorization request?
Prior authorization requests can usually be filled out online or by submitting specific forms provided by the insurance company.
What is the purpose of prior authorization request?
The purpose of prior authorization request is to ensure that the requested medical services are medically necessary and appropriate.
What information must be reported on prior authorization request?
Information such as patient demographics, diagnosis codes, procedure codes, and supporting clinical documentation must be reported on prior authorization requests.
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