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Request for Prior Authorization HEPATITIS C TREATMENTS, DIRECT ACTING ANTIVIRALS FAX Completed Form To 1 (800) 5742515 Provider Help Desk 1 (877) 7761567(PLEASE PRINT ACCURACY IS IMPORTANT) IA Medicaid
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How to fill out request for prior authorization

01
Contact your insurance company to obtain the prior authorization form.
02
Fill out the form completely with all required information.
03
Attach any relevant medical records or documentation to support your request.
04
Submit the completed form and documentation to the insurance company either via mail, fax, or online portal.
05
Follow up with the insurance company to ensure they received your request and monitor the status of the authorization.

Who needs request for prior authorization?

01
Healthcare providers such as doctors, hospitals, and therapists who plan to provide medical services that require prior authorization from the insurance company.
02
Patients who are requesting coverage for medical services that their insurance requires prior authorization for.
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Prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication.
Healthcare providers such as doctors, hospitals, or pharmacies are typically required to submit requests for prior authorization.
Providers must fill out a form provided by the insurance company with all necessary information about the patient and the requested treatment.
The purpose of prior authorization is to ensure that the treatment being requested is necessary and appropriate based on the patient's medical condition and insurance coverage.
The request must include information such as the patient's medical history, diagnosis, treatment plan, and justification for why the requested treatment is necessary.
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