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DEPARTMENT OF HEALTH SERVICES
Division of Health Care Access and Accountability
F00556A (07/12)STATE OF WISCONSIN
DHS 107.10(2), Wis. Admin. CodeFORWARDHEALTHPRIOR AUTHORIZATION DRUG ATTACHMENT FOR
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How to fill out prior authorization drug attachment
How to fill out prior authorization drug attachment
01
Obtain the prior authorization form for the drug attachment from your healthcare provider or insurance company.
02
Read the instructions and requirements carefully to ensure you have all the necessary information.
03
Fill out your personal information, including your name, date of birth, and contact details.
04
Provide your insurance information, including your policy number and group number.
05
Specify the drug details, such as the name, dosage, and quantity prescribed by your healthcare provider.
06
Include any supporting documentation required for the prior authorization, such as medical records or test results.
07
Sign and date the form, indicating that all the information provided is accurate to the best of your knowledge.
08
Submit the completed prior authorization drug attachment form to your healthcare provider or insurance company as instructed.
09
Follow up with your healthcare provider or insurance company to ensure the prior authorization process is completed successfully.
10
Keep a copy of the filled-out form and any supporting documentation for your records.
Who needs prior authorization drug attachment?
01
Prior authorization drug attachment is typically needed by patients who are prescribed medications that require prior approval from their insurance company.
02
These medications may include expensive or high-risk drugs, drugs not covered by the insurance plan, or drugs with alternative treatment options.
03
The prior authorization process helps insurance companies ensure the medical necessity and cost-effectiveness of the prescribed medication before providing coverage.
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What is prior authorization drug attachment?
Prior authorization drug attachment is a process where healthcare providers must obtain approval from the insurance company before certain medications are covered.
Who is required to file prior authorization drug attachment?
Healthcare providers are required to file prior authorization drug attachment.
How to fill out prior authorization drug attachment?
Prior authorization drug attachment can be filled out by providing all the necessary information about the patient, the medication, and the medical condition.
What is the purpose of prior authorization drug attachment?
The purpose of prior authorization drug attachment is to ensure that the medication being prescribed is medically necessary and cost-effective.
What information must be reported on prior authorization drug attachment?
The information that must be reported on prior authorization drug attachment includes patient information, prescriber information, medication details, and medical justification.
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