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PRIOR AUTHORIZATION FORM
Dazzle Medicare
Unless otherwise indicated below, authorization quantities are limited to the manufacturer
recommended dosageComplete online at www.selecthealth.org/pa or
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How to fill out darzalex - medicare
How to fill out darzalex - medicare
01
Obtain the darzalex medication from a healthcare provider or pharmacy.
02
Check the Medicare coverage for darzalex to ensure it is eligible for reimbursement.
03
Fill out the Medicare claim form with accurate information including the medication details, diagnosis code, and healthcare provider information.
04
Submit the completed claim form along with any required documentation to Medicare for processing.
Who needs darzalex - medicare?
01
Patients who have been prescribed darzalex for the treatment of multiple myeloma may need Medicare coverage to help with the cost of the medication.
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What is darzalex - medicare?
Darzalex (daratumumab) is a medication used to treat multiple myeloma, a type of blood cancer. It is often provided under Medicare to eligible patients.
Who is required to file darzalex - medicare?
Healthcare providers administering Darzalex to Medicare patients are required to file for reimbursement. Patients receiving the treatment generally do not file themselves.
How to fill out darzalex - medicare?
To file for Darzalex under Medicare, providers must complete the appropriate claim forms detailing the services provided, including diagnosis, treatment dates, and medication administration.
What is the purpose of darzalex - medicare?
The purpose of Darzalex under Medicare is to ensure that eligible patients have access to this medication as part of their cancer treatment coverage.
What information must be reported on darzalex - medicare?
Providers must report patient identification information, the specific treatment provided, ICD-10 codes for diagnosis, and National Drug Code (NDC) for Darzalex.
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