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HIV PREP TIER EXCEPTION REQUEST PRESCRIBER FAX FORM ONLY the prescriber may complete this form. This form is for prospective, concurrent, and retrospective reviews. By submitting this form, you attest

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How to fill out coverage exception prior authorization

01

Contact your insurance provider to inquire about coverage exceptions for your specific situation.

02

Obtain the necessary forms or documents required for the coverage exception request.

03

Fill out the forms completely and accurately, providing all relevant information and supporting documentation.

04

Submit the completed forms to your insurance provider as instructed.

05

Follow up with your insurance provider to ensure that your coverage exception request is being processed and approved.

Who needs coverage exception prior authorization?

01

Individuals who require medical treatments or services that are not typically covered by their insurance plan.

02

Patients who have received a denial for coverage of a certain treatment or service and are seeking an exception.

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What is coverage exception prior authorization?

Coverage exception prior authorization is a process where healthcare providers request approval from an insurance company to cover a treatment, medication, or procedure that is not typically covered under the patient's insurance plan.

Who is required to file coverage exception prior authorization?

Healthcare providers, such as doctors, hospitals, and pharmacies, are required to file coverage exception prior authorization on behalf of their patients.

How to fill out coverage exception prior authorization?

Healthcare providers can fill out coverage exception prior authorization forms either online or by submitting paper forms provided by the insurance company.

What is the purpose of coverage exception prior authorization?

The purpose of coverage exception prior authorization is to ensure that patients receive the necessary treatment, medication, or procedure even if it is not typically covered by their insurance plan.

What information must be reported on coverage exception prior authorization?

Information such as patient demographics, medical diagnosis, treatment plan, healthcare provider information, and supporting documentation must be reported on coverage exception prior authorization.

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