OPTUMRx Nuvigil & Provigil Prior Authorization Request Form 2014 free printable template

If you are not the intended recipient please notify the sender immediately and return the document s by mail to OptumRx Privacy Office 17900 Von Karman M/S CA016-0101 Irvine CA 92614. www. optumrx. com Office use only -NuvigilCMS2014Sep.doc Has SWSD been confirmed by one of the following select from the two options below Symptoms of excessive sleepiness or insomnia for at least 3 months which is temporally associated with a work period that occurs during the habitual sleep phase. Sleep study...

How to fill out OPTUMRx Nuvigil Provigil Prior Authorization Request

How to fill out OPTUMRx Nuvigil & Provigil Prior Authorization Request

1. Download the OPTUMRx Prior Authorization Request form for Nuvigil & Provigil from the OPTUMRx website.
2. Fill out the patient's information, including full name, date of birth, and insurance details.
3. Provide the prescribing physician's details, including name, contact information, and National Provider Identifier (NPI).
4. Indicate the medication (Nuvigil or Provigil) along with the required dosage and frequency.
5. Detail the patient's medical history, including previous therapies attempted and reasons for the current request.
6. Attach any supporting documentation or medical records that justify the need for the medication.
7. Review the form for completeness and accuracy to avoid processing delays.
8. Submit the completed form via fax or mail to the designated OPTUMRx Prior Authorization department.

Who needs OPTUMRx Nuvigil & Provigil Prior Authorization Request?

1. Patients prescribed Nuvigil or Provigil who are seeking insurance coverage for their medication.
2. Healthcare providers who need to ensure that the medications are approved for their patients prior to dispensing.

People Also Ask about

What kind of drugs need prior authorization?

What types of prescriptions require prior authorizations? Brand-name drugs that have a generic available. Drugs that are intended for certain age groups or conditions only. Drugs used only for cosmetic reasons. Drugs that are neither preventative nor used to treat non-life-threatening conditions.

Why do drugs require prior authorization?

Why does my health insurance company need a prior authorization? The prior authorization process gives your health insurance company a chance to review how necessary a medical treatment or medication may be in treating your condition. For example, some brand-name medications are very costly.

What triggers a prior authorization?

The prior authorization process begins when a service prescribed by a patient's physician is not covered by their health insurance plan. Communication between the physician's office and the insurance company is necessary to handle the prior authorization.

What are three drugs that require prior authorization?

Drugs That May Require Prior Authorization Drug ClassDrugs in ClassAndrogens-Anabolic SteroidsAndrol-50, Danazol, Nandrolone, OxandrinAnticoagulantsEliquis, Pradaxa, XareltoAntipsoriatic AgentsOtezla, Stelara, Taltz, TremfyaApokyn, KynmobiApokyn, Kynmobi240 more rows

How do I submit a prior authorization to OptumRx?

Submitting a PA request to OptumRx via phone or fax above. For urgent requests, please call us at 1-800-711-4555. (Hours: 5am PST to 10pm PST, Monday through Friday.)

How do I get a prior authorization for Adderall?

How Does Prior Authorization Work? Call your physician and ensure they have received a call from the pharmacy. Ask the physician (or his staff) how long it will take them to fill out the necessary forms. Call your insurance company and see if they need you to fill out any forms.

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What is OPTUMRx Nuvigil & Provigil Prior Authorization Request?

The OPTUMRx Nuvigil & Provigil Prior Authorization Request is a required process for healthcare providers to obtain approval from the insurance company before prescribing Nuvigil or Provigil. This process ensures that the medication is medically necessary and meets specific criteria set by the insurer.

Who is required to file OPTUMRx Nuvigil & Provigil Prior Authorization Request?

Healthcare providers, including physicians and prescribing practitioners, are required to file the OPTUMRx Nuvigil & Provigil Prior Authorization Request for their patients when they deem these medications necessary for treatment.

How to fill out OPTUMRx Nuvigil & Provigil Prior Authorization Request?

To fill out the OPTUMRx Nuvigil & Provigil Prior Authorization Request, providers must complete the request form with patient information, including diagnosis, treatment history, proposed therapy, and any relevant medical documentation to support the necessity of the medication.

What is the purpose of OPTUMRx Nuvigil & Provigil Prior Authorization Request?

The purpose of the OPTUMRx Nuvigil & Provigil Prior Authorization Request is to ensure that patients are prescribed these medications only when medically justified, thus controlling costs and ensuring appropriate use of the drugs.

What information must be reported on OPTUMRx Nuvigil & Provigil Prior Authorization Request?

The information that must be reported includes the patient's name, date of birth, medical history, diagnosis, previous treatments tried, the prescribed dosage of Nuvigil or Provigil, and any supporting documentation that demonstrates the need for the medication.