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Prior Authorization Request Send completed form to: Case Review Unit CVS/earmark Specialty Programs Fax: 866-249-6155 CVS/earmark administers the prescription benefit plan for the patient identified.

How to fill out prior authorization request

How to fill out a prior authorization request:

1. Start by obtaining the necessary forms from your healthcare provider or insurance company. These forms may be available online or you can request them directly.
2. Carefully review the instructions provided with the prior authorization request forms. Make sure you understand all the information required and any supporting documents that might be necessary.
3. Gather all the required information before filling out the form. This may include details such as patient information, healthcare provider information, treatment codes, medication details, and supporting medical documentation.
4. Begin by filling out the patient information section, including the full name, date of birth, address, and insurance details of the individual requiring the prior authorization.
5. Provide the healthcare provider's information, including their name, contact details, and their National Provider Identifier (NPI) number if applicable.
6. Specify the treatment or medication for which you are seeking prior authorization. This may involve providing the correct procedure codes, medication names, dosages, and any necessary frequency or duration information.
7. Explain the reason for the prior authorization request. This may involve providing clinical justifications, medical necessity, and any supporting documentation, such as medical records or test results.
8. Double-check all the information you have provided to ensure accuracy and completeness. This helps avoid any delays or denial of the prior authorization request.
9. If required, make a copy of the completed form for your records before submitting it to your healthcare provider or insurance company.
10. Submit the prior authorization request form through the designated method specified by your healthcare provider or insurance company. This can be via mail, fax, or online submission through a secure portal.
11. Keep a record of the date and time when you submitted the prior authorization request. It is also helpful to keep a copy of any supporting documents sent with the request.
12. Wait for a response from your insurance company. The timeframe for a decision may vary, so it is advisable to follow up on the status of your prior authorization request if you haven't heard back within a reasonable time frame.

Who needs prior authorization request?

1. Individuals who require certain medical treatments, procedures, or medications that may not be automatically covered by their insurance plan.
2. Healthcare professionals who need to seek approval from the insurance company before providing specific treatments or prescribing certain medications.
3. Insurance companies require prior authorization requests to assess the medical necessity and cost-effectiveness of the requested treatment or medication before providing coverage.

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What is prior authorization request?

Prior authorization is a process used by some health insurers to determine if they will cover a prescribed procedure, service, or medication.

Who is required to file prior authorization request?

Healthcare providers or patients may be required to file a prior authorization request depending on the insurance company's policy.

How to fill out prior authorization request?

Prior authorization requests can usually be submitted online, by phone, or through fax. The requester must provide specific information about the patient, the prescribed treatment, and the healthcare provider.

What is the purpose of prior authorization request?

The purpose of prior authorization is to ensure that the requested treatment is medically necessary and appropriate before the insurance company agrees to cover the cost.

What information must be reported on prior authorization request?

The prior authorization request typically requires information such as patient demographics, healthcare provider details, diagnosis codes, treatment codes, and supporting medical documentation.