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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F00162A (07/2017)STATE OF WISCONSIN Wis. Admin. Code DHS 107.10(2)FORWARDHEALTHPRIOR AUTHORIZATION DRUG ATTACHMENT FOR ISOTROPIC, OMEGA3

How to fill out prior authorization drug attachment

How to fill out prior authorization drug attachment

1. To fill out a prior authorization drug attachment, follow these steps:
2. Start by contacting your healthcare provider or the insurance company to obtain the prior authorization drug attachment form.
3. Read the instructions carefully to understand the necessary information and supporting documents required.
4. Begin filling out the form by providing your personal details such as name, date of birth, contact information, and insurance information.
5. Follow the guidelines to list the prescribed drug or medication requiring prior authorization. Include the dosage, frequency, and duration of the prescription.
6. Attach any supporting documents that are required, such as medical records, test results, or a letter of medical necessity from your healthcare provider.
7. Review the completed form and attached documents for accuracy and completeness.
8. Submit the filled-out prior authorization drug attachment form along with any necessary supporting documents to your insurance company.
9. Keep a copy of the form and supporting documents for your records.
10. Wait for a response from your insurance company regarding the approval or denial of the prior authorization request.
11. Follow up if necessary and consult with your healthcare provider for any further steps or alternatives.

Who needs prior authorization drug attachment?

1. Prior authorization drug attachment is typically required by individuals who:
2. - Are prescribed a medication that requires prior approval from their insurance company.
3. - Have a specific insurance plan that mandates prior authorization for certain drugs.
4. - Seek coverage for a drug that is not on their insurance company's formulary list.
5. - Require a higher dosage or a longer duration of medication than what is considered standard.
6. It is important to check with your insurance provider or healthcare provider to determine if you need to submit a prior authorization drug attachment for your particular medication.

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