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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F00805A (07/2022)STATE OF WISCONSIN Wis. Admin. Code DHS 107.10(2)FORWARDHEALTHPRIOR AUTHORIZATION DRUG ATTACHMENT FOR MULTIPLE SCLEROSIS

How to fill out prior authorization drug attachment

How to fill out prior authorization drug attachment

1. Obtain the prior authorization drug attachment form from your healthcare provider or insurance company.
2. Fill out the patient's demographic information, including name, date of birth, and insurance information.
3. Provide the details of the prescribed medication, including the name, strength, dosage, and frequency.
4. Include any supporting documentation, such as medical records or test results, to justify the need for the medication.
5. Submit the completed prior authorization drug attachment form to your healthcare provider or insurance company for review.

Who needs prior authorization drug attachment?

1. Individuals who have been prescribed a medication that requires prior authorization from their insurance company.
2. Healthcare providers who need to request approval for a specific medication on behalf of their patients.

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What is prior authorization drug attachment?

Prior authorization drug attachment is a document that is required to be submitted before a health insurance company will agree to cover the cost of a specific medication.

Who is required to file prior authorization drug attachment?

Healthcare providers or pharmacists are typically required to file prior authorization drug attachment on behalf of their patients.

How to fill out prior authorization drug attachment?

Prior authorization drug attachment can be filled out by providing details about the patient, the medication being prescribed, and the medical necessity for the medication.

What is the purpose of prior authorization drug attachment?

The purpose of prior authorization drug attachment is to ensure that the prescribed medication is medically necessary and appropriate for the patient's condition.

What information must be reported on prior authorization drug attachment?

Information such as patient demographics, the medication name, dosage, frequency, diagnosis, and supporting medical documentation may need to be reported on prior authorization drug attachment.