Get the free Virginia Medicaid Service Authorization Form: Topical Antifungals ...
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Prior Authorization Form
Topical Antifungal Agents: Ciclopirox (Pen lac, Cnl8),
Efinaconazole (Julia), Lulizonazole (Lulu), Tavaborole (Keratin)
Please note, this communication applies to Anthem Healthineers
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How to fill out virginia medicaid service authorization
How to fill out virginia medicaid service authorization
01
Log in to the Virginia Medicaid portal.
02
Click on the 'Service Authorization' tab.
03
Select the appropriate service from the list.
04
Fill out the required information including patient details, service provider information, and service requested.
05
Submit the authorization request for review.
Who needs virginia medicaid service authorization?
01
Individuals who are eligible for Virginia Medicaid benefits and require specific services that need prior authorization.
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