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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F03175 (07/2023)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 necessary prior authorization drug attachment form from the insurance company or healthcare provider.
2. Fill out the patient's personal information such as name, date of birth, and insurance ID number.
3. Provide details about the prescribed medication including the name, dosage, frequency, and duration of treatment.
4. Include any relevant medical history or diagnosis that supports the need for the prescribed medication.
5. Submit the completed prior authorization drug attachment form along with any required documents to the appropriate party for review.

Who needs prior authorization drug attachment?

1. Patients who are prescribed medications that require prior authorization from their insurance company.
2. Healthcare providers who are seeking approval for specific medications on behalf of their patients.

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What is prior authorization drug attachment?

Prior authorization drug attachment is a document that provides details about the medication being prescribed by a healthcare provider and the reasons why it is necessary for the patient's treatment plan.

Who is required to file prior authorization drug attachment?

Healthcare providers, pharmacies, and insurance companies are typically required to file prior authorization drug attachment as part of the approval process for certain medications.

How to fill out prior authorization drug attachment?

To fill out a prior authorization drug attachment, the provider must include information such as the patient's diagnosis, medication details, and the healthcare provider's rationale for prescribing 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, as well as to help control costs and prevent unnecessary prescriptions.

What information must be reported on prior authorization drug attachment?

Information such as the patient's personal details, diagnosis, medication details, healthcare provider's information, and the reason for prescribing the medication must be reported on prior authorization drug attachment.