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Prior Authorization Request Send completed form to: Case Review Unit, CVS Earmark Prior Authorization Fax: 18662496155 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. Gather all the necessary information and documents required for the prior authorization request.
2. Contact the insurance company or healthcare provider to obtain the necessary prior authorization request form.
3. Fill out the prior authorization request form accurately and completely, providing all the required information.
4. Attach any supporting documentation or medical records that may be required for the prior authorization request.
5. Submit the completed prior authorization request form along with the supporting documents to the designated department or address specified by the insurance company or healthcare provider.
6. Follow up with the insurance company or healthcare provider to ensure that the prior authorization request is received and processed in a timely manner.
7. Keep copies of all the submitted documents and correspondence related to the prior authorization request for future reference.

Who needs prior authorization request?

1. Individuals who require certain medical treatments, procedures, medications, or services that are not automatically covered by their health insurance plan may need to submit a prior authorization request.

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What is prior authorization request?

A prior authorization request is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication before the service is provided.

Who is required to file prior authorization request?

Typically, the healthcare provider or the patient, depending on the insurance company policies, is required to file a prior authorization request.

How to fill out prior authorization request?

To fill out a prior authorization request, you must complete a form provided by the insurance company, including patient information, diagnosis, requested service or medication, and medical necessity justification.

What is the purpose of prior authorization request?

The purpose of a prior authorization request is to ensure that the proposed treatment or service is medically necessary and appropriate according to the health plan's coverage criteria.

What information must be reported on prior authorization request?

The information generally required includes patient demographics, insurance details, diagnosis codes, treatment or medication details, and supporting clinical evidence.