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Immediate Release Opioid Prior Authorization FormPrescribers: Please fax form to (800) 9615160. For provider/physician inquiries, call (855) 3224079. Date of Request://Member Information Member Name:DOB:/Member

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How to fill out immediate release opioid prior

01

Step 1: Start by gathering all the necessary information and documents related to the immediate release opioid prescription.

02

Step 2: Read and understand the prescription instructions, dosage recommendations, and any specific guidance provided by the healthcare professional.

03

Step 3: Prepare the immediate release opioid medication as directed, ensuring proper handling and storage.

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Step 4: Fill out the immediate release opioid prior authorization form completely and accurately. Provide all the requested information, including personal details, healthcare provider information, prescription details, and any supporting documentation.

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Step 5: Double-check the filled-out form for any errors or missing information.

06

Step 6: Submit the completed prior authorization form through the designated channels, such as your healthcare provider's office or the insurance company's online portal.

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Step 7: Follow up with the healthcare provider or insurance company to ensure the prior authorization process is completed successfully.

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Step 8: Wait for the approval notification from the insurance company before obtaining the immediate release opioid medication.

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Step 9: If the prior authorization request is denied, consult with the healthcare provider or insurance company for further guidance.

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Step 10: Once approved, pick up the immediate release opioid medication from the designated pharmacy or receive it through mail delivery.

Who needs immediate release opioid prior?

01

Individuals who require immediate relief from acute pain conditions may need immediate release opioid prior authorization.

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Patients with a documented medical condition, as determined by their healthcare provider, which necessitates the use of immediate release opioids for pain management may also require prior authorization.

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