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Prior Authorization Request Send completed form to: Case Review Unit, CVS Earmark Prior Authorization Fax: 18662496155 CVS Earmark administers the prescription benefit plan for the patient identified.

How to fill out prior authorization request

How to fill out prior authorization request

1. To fill out a prior authorization request, follow these steps:
2. Obtain the necessary prior authorization form from the insurance company or online portal.
3. Provide the patient's information, including name, date of birth, and insurance details.
4. Include the healthcare provider's information, such as name, contact details, and NPI number.
5. Specify the medication, treatment, or procedure for which prior authorization is being requested.
6. Attach supporting documentation, such as medical records, test results, or clinical notes.
7. Indicate the reason for the request, including the medical necessity or alternative treatments.
8. Complete any additional fields or questions required by the insurance company.
9. Verify that all information is accurate and legible.
10. Submit the prior authorization request via fax, email, or online submission method as instructed by the insurance company.
11. Keep a copy of the submitted request for your records.
12. Follow up with the insurance company to track the status of the prior authorization request.
13. Upon receiving approval or denial, inform the patient and proceed accordingly.

Who needs prior authorization request?

1. Prior authorization requests are typically required by insurance companies.
2. Healthcare providers, such as doctors, specialists, or hospitals, need to submit prior authorization requests for certain medications, treatments, or procedures.
3. Patients or their caregivers may also play a role in preparing the necessary information for the prior authorization request.

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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 service.

Who is required to file prior authorization request?

Healthcare providers are typically required to file prior authorization requests on behalf of their patients.

How to fill out prior authorization request?

Prior authorization requests can be filled out online or by submitting a specific form provided by the insurance company.

What is the purpose of prior authorization request?

The purpose of prior authorization request is to ensure that a prescribed medication or medical service is medically necessary before the insurance company agrees to cover it.

What information must be reported on prior authorization request?

Information such as patient demographics, diagnosis, prescribed treatment, and supporting clinical documentation must be reported on a prior authorization request.