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Multiple Sclerosis (for Maryland only)
Prior Authorization Request
Send completed form to: Case Review Unit, CVS Earmark Prior Authorization Fax: 18662496155
CVS Earmark administers the prescription
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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 treatment, procedure, or medication before it is done.
Who is required to file prior authorization request?
Healthcare providers, such as doctors and hospitals, are usually responsible for filing prior authorization requests on behalf of their patients.
How to fill out prior authorization request?
To fill out a prior authorization request, healthcare providers typically need to provide detailed information about the patient's condition, the prescribed treatment, and why it is necessary.
What is the purpose of prior authorization request?
The purpose of a prior authorization request is to ensure that the proposed treatment is medically necessary and appropriate, and to prevent unnecessary or wasteful spending on healthcare services.
What information must be reported on prior authorization request?
Information that must be reported on a prior authorization request typically includes the patient's demographic information, medical history, diagnosis, proposed treatment, and supporting documentation.
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