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Michigan Prior Authorization Request Form
For Prescription Drugs Instructions
Important: Please read all instructions below before completing IS 2288.
Section 2212c of Public Act 218 of 1956, MCL
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How to fill out an expedited prior authorization

How to fill out an expedited prior authorization
01
To fill out an expedited prior authorization, follow these steps:
02
Gather all the required information and documentation, such as the patient's information, medical history, and supporting medical records.
03
Contact the insurance company or healthcare provider to obtain the necessary forms for the prior authorization request.
04
Fill out the forms accurately and completely. Make sure to provide all necessary details and attach any relevant supporting documents.
05
Clearly state the reason for the expedited request, emphasizing the urgency and the potential harm or detrimental effects if the prior authorization is delayed.
06
Submit the fully completed forms and supporting documents to the designated contact or department within the insurance company or healthcare provider.
07
Follow up promptly with the insurance company or healthcare provider to ensure that the prior authorization request is being processed expediently.
08
Maintain detailed records of all communications and interactions related to the prior authorization request for future reference.
09
If necessary, escalate the request to a supervisor or manager if there are undue delays or issues with the prior authorization process.
Who needs an expedited prior authorization?
01
An expedited prior authorization may be needed by:
02
- Patients who require immediate access to certain medications, treatments, or procedures that are not covered without prior authorization.
03
- Patients with urgent or life-threatening medical conditions that necessitate timely approval for necessary medical interventions.
04
- Healthcare providers who need to quickly obtain approval for specific tests, surgeries, or medical interventions to ensure the best possible care for their patients.
05
- Emergency medical services and providers who need to access specialized treatments or equipment on an urgent basis.
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What is an expedited prior authorization?
An expedited prior authorization is a process where healthcare providers can request approval from a health insurance company for certain medical services or medications in a shorter amount of time.
Who is required to file an expedited prior authorization?
Healthcare providers are typically required to file an expedited prior authorization in order to receive reimbursement for certain medical services or medications.
How to fill out an expedited prior authorization?
To fill out an expedited prior authorization, healthcare providers usually need to provide information about the patient, the requested service or medication, and the medical necessity of the request.
What is the purpose of an expedited prior authorization?
The purpose of an expedited prior authorization is to ensure that patients receive timely access to necessary medical services or medications while also controlling costs for health insurance companies.
What information must be reported on an expedited prior authorization?
Information that must be reported on an expedited prior authorization typically includes patient demographics, medical history, the requested service or medication, and the reason for the request.
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