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DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F-01247A (08/15) STATE OF WISCONSIN Wis. Admin. Code DHS 107.10(2) FORWARDHEALTH PRIOR AUTHORIZATION DRUG ATTACHMENT

How to fill out prior authorization drug attachment

How to fill out prior authorization drug attachment:

1. Begin by gathering all the necessary information and documents for the prior authorization drug attachment. This may include the patient's personal information, medical history, diagnosis, prescription details, and any supporting documents from the healthcare provider.
2. Fill out the patient's personal information accurately, including their full name, date of birth, address, and contact information. This information is essential for identification purposes and to ensure effective communication throughout the process.
3. Provide the relevant medical history of the patient. Include any previous treatments, medications, surgeries, or allergies that may be pertinent to the current prescription. This information allows the insurance company to assess the medical necessity of the drug and determine if the prior authorization is required.
4. Clearly state the diagnosis for which the prescribed drug is intended. Provide the necessary supporting documentation, such as test results or physician notes, to validate the medical need for the medication.
5. Fill in the details of the prescribed drug accurately. Include the drug's name, dosage, strength, frequency, and duration of the prescription. It is crucial to double-check this information to avoid any discrepancies that may delay the prior authorization process.
6. Attach any additional supporting documentation that may strengthen the case for prior authorization. This can include peer-reviewed studies, clinical trial data, or documentation from the prescribing healthcare provider explaining why alternative treatments have been deemed ineffective or inappropriate.
7. Review the completed prior authorization drug attachment form thoroughly before submission. Ensure that all sections are filled out accurately and completely. Any missing or incorrect information can lead to a delay or denial of the prior authorization request.
8. Submit the completed form and all necessary documents to the appropriate department or address provided by the insurance company. Be sure to follow any specific instructions or guidelines given by the insurer to avoid any complications or delays in the prior authorization process.

Who needs prior authorization drug attachment?

1. Patients who require medications that are not covered by their insurance or fall under specific restrictions may need to submit a prior authorization drug attachment. This process helps insurance companies determine the medical necessity of the prescribed medication and whether it should be covered under the patient's policy.
2. Healthcare providers or physicians prescribing medications that require prior authorization may have to fill out the drug attachment form. They need to provide all relevant information and supporting documentation to justify the need for the medication and expedite the prior authorization process.
3. Pharmacists may also be involved in the prior authorization process, as they play a crucial role in ensuring the accuracy of the information provided on the drug attachment form. They may need to review the submitted documents and communicate with the insurance company to facilitate the prior authorization process.

For pdfFiller’s FAQs

What is prior authorization drug attachment?

Prior authorization drug attachment is a process where healthcare providers must obtain approval from insurance companies before prescribing certain medications to their patients.

Who is required to file prior authorization drug attachment?

Healthcare providers, such as doctors and pharmacists, are required to file prior authorization drug attachment.

How to fill out prior authorization drug attachment?

To fill out prior authorization drug attachment, healthcare providers must provide information about the patient's medical condition, the prescribed medication, and the reason for the prescription.

What is the purpose of prior authorization drug attachment?

The purpose of prior authorization drug attachment is to ensure that patients receive appropriate medications and that insurance companies are not billed for unnecessary or inappropriate treatments.

What information must be reported on prior authorization drug attachment?

The information reported on prior authorization drug attachment includes patient's medical history, prescribed medication, dosage, duration of treatment, and healthcare provider's credentials.

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