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DEPARTMENT OF HEALTH SERVICES Division Medicaid Services F00163 (07/2024)STATE OF WISCONSIN Wis. Admin. Code DHS 107.10(2)FORWARDHEALTHPRIOR AUTHORIZATION DRUG ATTACHMENT FOR ANTIOBESITY DRUGS INSTRUCTIONS:

How to fill out prior authorization drug attachment

How to fill out prior authorization drug attachment

1. Obtain the prior authorization drug attachment form from your insurance provider or download it from their website.
2. Fill out all required patient information including name, date of birth, and insurance information.
3. Provide details of the prescribed medication such as name, dosage, frequency, and quantity.
4. Include information on the medical condition being treated and the reason for the medication.
5. Attach any relevant medical records or supporting documentation as requested.
6. Review the form for accuracy and completeness before submitting it to your insurance provider.

Who needs prior authorization drug attachment?

1. Individuals who have been prescribed a medication that requires prior authorization from their insurance provider.
2. Healthcare providers or pharmacists who are submitting the medication request on behalf of a patient.

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What is prior authorization drug attachment?

Prior authorization drug attachment is a document or submission that healthcare providers must complete to obtain approval from insurance companies or health plans before prescribing certain medications. This process ensures that a prescribed drug is medically necessary and meets the plan's guidelines.

Who is required to file prior authorization drug attachment?

Healthcare providers, including physicians and pharmacists, are required to file prior authorization drug attachment on behalf of patients when prescribed medications that require prior approval from the insurance provider.

How to fill out prior authorization drug attachment?

To fill out a prior authorization drug attachment, providers must gather relevant patient information, including medical history and the specific medication requested. They should complete the required forms provided by the insurance company, ensuring all sections are filled accurately and any necessary documentation is attached.

What is the purpose of prior authorization drug attachment?

The purpose of prior authorization drug attachment is to control healthcare costs by ensuring that patients receive medications that are medically necessary and appropriate for their conditions before the insurance company provides coverage.

What information must be reported on prior authorization drug attachment?

Information that must be reported includes patient demographic details, prescribing provider's information, medication name, dosage, frequency, and justification for the medication's necessity along with any supporting clinical information.