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Prior Authorization Request Send completed form to: Case Review Unit CVS/earmark Specialty Programs Fax: 8662496155 CVS/earmark administers the prescription benefit plan for the patient identified.

How to fill out prior authorization request

1. To fill out a prior authorization request, obtain the appropriate form from your insurance company or healthcare provider. It is usually available online or can be requested over the phone.
2. Begin by providing your personal information on the form, including your name, date of birth, contact information, and insurance policy details. Double-check the accuracy of this information to avoid any processing delays.
3. Next, provide the information of the healthcare provider who is prescribing the treatment or medication that requires prior authorization. This includes the provider's name, contact information, and their National Provider Identifier (NPI) number.
4. Clearly state the treatment or medication that you are seeking prior authorization for. Include the name, dosage, and frequency if applicable. Provide any additional relevant information, such as the reason for the request, alternative treatments tried, or supporting documentation from the provider.
5. If applicable, include any supporting documentation with the prior authorization request form. This may include medical records, test results, or a letter of medical necessity from your healthcare provider. Make sure to include copies and not original documents as they may not be returned.
6. Review the completed form to ensure all sections are accurately filled out. Check for any errors or missing information that could lead to delays or denial. It may be helpful to have a trusted person review the form as well for a fresh perspective.
7. Once the form is completed, follow the instructions provided by your insurance company or healthcare provider on how to submit the prior authorization request. This may include mailing the form, faxing it, or submitting it electronically through an online portal.
8. It is important to keep a copy of the completed prior authorization form, along with any supporting documentation, for your records. This will help in case of any disputes or if you need to reference the information later.
9. Who needs prior authorization requests? Prior authorization requests are typically required for specific treatments, medications, or procedures that may require additional review by the insurance company to determine coverage and medical necessity. This can vary depending on your insurance plan and its guidelines. It is important to check with your insurance provider or healthcare professional to determine if a prior authorization request is necessary for your specific situation.

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What is prior authorization request?

Prior authorization request is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication before it is provided or dispensed.

Who is required to file prior authorization request?

Healthcare providers, such as doctors, hospitals, and pharmacists, are often required to file prior authorization requests with the patient's insurance company.

How to fill out prior authorization request?

Prior authorization requests can usually be filled out online or by submitting a form provided by the insurance company. The form will require information such as the patient's diagnosis, the recommended treatment, and supporting medical documentation.

What is the purpose of prior authorization request?

The purpose of a prior authorization request is to ensure that the recommended treatment is medically necessary and appropriate before the insurance company agrees to cover it.

What information must be reported on prior authorization request?

Information that must be reported on a prior authorization request typically includes the patient's personal information, the treating provider's information, the diagnosis, the recommended treatment, and any supporting medical documentation.