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Iowa Department of Human ServicesRequest for Prior Authorization
HEPATITIS C TREATMENTS, DIRECT ACTING
ANTIVIRALS FAX Completed Form
To
1 (800) 5742515
Provider Help Desk
1 (877) 7761567(PLEASE PRINT
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How to fill out request for prior authorization
How to fill out request for prior authorization
01
Contact your insurance provider to obtain the necessary forms for prior authorization.
02
Fill out the requested information on the form accurately and completely.
03
Attach any required supporting documentation, such as medical records or test results.
04
Submit the completed form and documentation to your insurance provider, either online or by mail.
05
Wait for a response from your insurance provider regarding the approval or denial of the prior authorization request.
Who needs request for prior authorization?
01
Patients who require a specific medical treatment, procedure, or medication that is not typically covered by their insurance plan without prior authorization.
02
Healthcare providers who are prescribing or recommending a treatment or procedure that requires prior authorization from the patient's insurance provider.
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What is request for prior authorization?
Prior authorization is a process used by insurance companies to determine if they will cover a prescribed medical procedure or medication before it is done or dispensed.
Who is required to file request for prior authorization?
Healthcare providers, including doctors and hospitals, are typically required to submit the request for prior authorization to the patient's insurance company.
How to fill out request for prior authorization?
The healthcare provider must fill out the request form with all relevant patient and procedure information, including diagnosis, treatment plan, and medical necessity.
What is the purpose of request for prior authorization?
The purpose of a prior authorization request is to obtain approval from the insurance company for coverage of a specific medical procedure or medication.
What information must be reported on request for prior authorization?
The request must include patient information, healthcare provider information, diagnosis, treatment plan, medical necessity, and any supporting documentation.
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