Get the free Trulance Prior Authorization of Benefits Form

This form is used to request prior authorization for the medication Trulance (plecanatide) for patients diagnosed with chronic idiopathic constipation, irritable bowel syndrome with constipation (IBS-C), or other specified conditions. It requires the completion of patient and physician information, medication details, diagnosis, and approval criteria to assess eligibility for coverage under Texas Medicaid.

How to fill out trulance prior authorization of

How to fill out trulance prior authorization of

1. Obtain the Trulance prior authorization form from your insurance provider's website or customer service.
2. Fill out the patient's personal information, including name, date of birth, and insurance details.
3. Provide the prescribing physician's information, including name, contact number, and NPI number.
4. Indicate the diagnosis that necessitates the use of Trulance, supported by appropriate ICD-10 codes.
5. Include details of previous treatments tried and the reasons they were discontinued, if applicable.
6. Specify the prescribed dosage and duration for Trulance treatment.
7. Attach any relevant medical records or documentation that support the need for Trulance.
8. Review the completed form for accuracy and completeness.
9. Submit the form to the insurance provider via the specified method (fax, online submission, etc.).
10. Follow up with the insurance provider to confirm receipt and inquire about the status of the authorization.

Who needs trulance prior authorization of?

1. Patients diagnosed with chronic idiopathic constipation or opioid-induced constipation who require treatment with Trulance.
2. Individuals whose insurance plans require prior authorization for medications like Trulance before dispensing.

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What is trulance prior authorization of?

Trulance prior authorization refers to the process required by insurance companies to approve coverage for the medication Trulance before a patient can receive it.

Who is required to file trulance prior authorization of?

Healthcare providers such as physicians or specialists prescribing Trulance are typically required to file prior authorization requests on behalf of the patient.

How to fill out trulance prior authorization of?

To fill out Trulance prior authorization, a provider must complete a form detailing the patient's medical history, diagnosis, treatment plan, and justification for the medication.

What is the purpose of trulance prior authorization of?

The purpose of Trulance prior authorization is to ensure that the medication is medically necessary and appropriate for the patient's condition before insurance coverage is provided.

What information must be reported on trulance prior authorization of?

Information that must be reported includes patient identification details, diagnosis codes, previous treatment history, and the rationale for prescribing Trulance.