Get the free Synagis Prior Authorization Request (PAR) - Colorado.gov

Refer to the 2016 2017 Provider Bulletin for more information. The 2016 2017 season will begin November 30 2016 and end April 30 2017. Requests for that do not meet the AAP indications listed on the Colorado Medicaid Pharmacy Benefit PAR Form online will be DENIED. All Pharmacy PARs must be signed by the prescribing physician even if submitted by an agent of the prescriber. As an example if 100mg is needed use a 100mg vial and not two 2 50mg vials. The chart below provides details regarding...

How to fill out synagis prior authorization request

How to fill out synagis prior authorization request

1. Gather all necessary patient information, including the patient's medical history and relevant diagnostic test results.
2. Obtain the Synagis prior authorization request form from the appropriate healthcare insurance provider or download it from their website.
3. Fill out the patient's personal information section on the form, including their name, date of birth, and contact information.
4. Provide the patient's medical diagnosis and any relevant supporting documentation.
5. Include details about the patient's medical necessity for Synagis, such as a history of premature birth or respiratory syncytial virus (RSV) risk factors.
6. Complete all required fields on the form, including dosing information and treatment duration.
7. Attach any additional supporting documentation, such as a prescription or letters of medical necessity from the treating physician.
8. Review the completed form for accuracy and ensure all required information is provided.
9. Submit the Synagis prior authorization request form to the appropriate healthcare insurance provider either online, through fax, or by mail.
10. Follow up with the insurance provider to check the status of the prior authorization request and address any additional information or documentation requests.
11. If the prior authorization is approved, communicate with the patient's healthcare provider to initiate the process of obtaining and administering Synagis.

Who needs synagis prior authorization request?

1. Children who are at high risk of developing severe respiratory syncytial virus (RSV) infections may require a Synagis prior authorization request.
2. Premature infants born before 29 weeks of gestation and certain high-risk infants born before 32 weeks of gestation are often eligible for Synagis.
3. Infants with chronic lung disease, congenital heart disease, or other specific medical conditions may also require a prior authorization for Synagis.
4. The decision to request Synagis prior authorization should be made in consultation with the treating physician and based on the patient's individual risk factors and medical history.

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What is synagis prior authorization request?

Synagis prior authorization request is a process where healthcare providers must seek approval from the insurance company before administering the medication to a patient.

Who is required to file synagis prior authorization request?

Healthcare providers such as doctors, nurses, and hospitals are required to file synagis prior authorization requests.

How to fill out synagis prior authorization request?

To fill out a synagis prior authorization request, healthcare providers need to provide patient information, medical necessity documentation, and any other required supporting documentation.

What is the purpose of synagis prior authorization request?

The purpose of synagis prior authorization request is to ensure that the medication is only administered to patients who meet specific criteria set by the insurance company.

What information must be reported on synagis prior authorization request?

The information that must be reported on synagis prior authorization request includes patient demographics, medical history, diagnosis, and the prescriber's information.

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