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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F00238A (07/2020)STATE OF WISCONSIN Wis. Admin. Code DHS 107.10(2)FORWARDHEALTHPRIOR AUTHORIZATION DRUG ATTACHMENT FOR GLUCAGONLIKE PEPTIDE
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How to fill out prior authorization drug attachment
How to fill out prior authorization drug attachment
01
Obtain the prior authorization form from either the insurance company or healthcare provider.
02
Provide the necessary information such as patient demographics, insurance details, prescriber information, and drug details.
03
Include any required supporting documentation such as medical records or clinical notes.
04
Submit the completed prior authorization form and attachments to the designated address or fax number.
05
Wait for a response from the insurance company regarding the approval or denial of the prior authorization request.
Who needs prior authorization drug attachment?
01
Patients who are prescribed medications that require prior authorization from their insurance company.
02
Healthcare providers who need to obtain approval from insurance companies before certain medications can be covered.
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What is prior authorization drug attachment?
Prior authorization drug attachment is a process where healthcare providers must obtain approval from an insurance company before prescribing certain medications.
Who is required to file prior authorization drug attachment?
Healthcare providers, such as doctors and pharmacists, are required to file prior authorization drug attachment.
How to fill out prior authorization drug attachment?
Providers need to complete a form with patient information, medical necessity details, and medication details to fill out prior authorization drug attachment.
What is the purpose of prior authorization drug attachment?
The purpose of prior authorization drug attachment is to ensure that patients receive the most appropriate and cost-effective medications.
What information must be reported on prior authorization drug attachment?
Patient demographics, diagnosis, medication name, dosage, duration, and reasons for requesting the medication must be reported on prior authorization drug attachment.
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