Get the free Kalydeco PSC Prior Authorization Form - static.cigna.com

Irenic (federating)Fax completed form to: (855) 8401678 If this is an URGENT request, please call (800) 8824462 (800.88.CHINA)PHYSICIAN INFORMATIONPATIENT INFORMATION* Physician Name: Specialty:*Due

How to fill out kalydeco psc prior authorization

How to fill out kalydeco psc prior authorization

1. To fill out a Kalydeco PSC prior authorization, follow these steps:
2. Download the Kalydeco PSC prior authorization form from the healthcare provider's website or request a copy from their office.
3. Read the instructions and requirements provided on the form carefully.
4. Fill in the patient's personal information, including name, date of birth, address, and contact details.
5. Provide the patient's insurance information, such as the insurance company name, policy number, and group number.
6. Attach all necessary supporting documents, including medical records, lab test results, and any relevant prescriptions.
7. Have the prescribing healthcare provider complete their section of the form, including their name, contact information, and signature.
8. Review the completed form for accuracy and completeness.
9. Submit the filled-out Kalydeco PSC prior authorization form to the designated address or fax number provided on the form.
10. Follow up with the healthcare provider or insurance company to ensure the form has been received and processed.
11. Note: It is recommended to keep a copy of the filled-out form for your records.

Who needs kalydeco psc prior authorization?

1. Kalydeco PSC prior authorization is required for individuals who need to access Kalydeco medication for the treatment of cystic fibrosis.
2. This authorization process ensures that the prescribed medication meets the necessary criteria and is covered by the patient's insurance plan.
3. Patients who have been diagnosed with cystic fibrosis by their healthcare provider and have been recommended Kalydeco may need to undergo the prior authorization process.
4. Individuals who are unsure if their insurance requires prior authorization for Kalydeco should consult with their healthcare provider or insurance company for clarification.

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