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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

How to fill out a prior authorization request:

1. Gather all necessary information: Before starting the form, make sure you have all the required details such as the patient's personal information, insurance information, and the medication or medical procedure requiring prior authorization.
2. Understand the specific requirements: Different insurance providers may have their own forms or specific guidelines for filling out a prior authorization request. Familiarize yourself with these requirements to ensure accuracy and prevent delays in the approval process.
3. Complete the patient section: Begin by filling out the patient's information, including their name, date of birth, address, and contact details. Double-check that all information is accurate and up-to-date.
4. Provide insurance information: Enter the patient's insurance details, including the name of the insurance provider, the policy or group number, and any additional relevant information.
5. Indicate the medication or procedure requiring prior authorization: Clearly state the medication or medical procedure that needs authorization. Include the dosage, frequency, and any specific instructions or information provided by the healthcare provider.
6. Attach supporting documents: Some prior authorization requests may require additional supporting documents, such as medical records or doctor's notes. Ensure you have all the necessary documentation before submitting the request, and attach them as instructed.
7. Review and double-check: Before submitting the prior authorization request, carefully review all the entered information to avoid any errors or omissions. Small mistakes can lead to delays or denials, so take the time to verify everything.
8. Submit the request: Once you have completed the form and attached any required documents, follow the instructions provided to submit the prior authorization request. This may involve mailing it to the appropriate address, faxing it, or submitting it online through a portal or website.

Who needs a prior authorization request?

1. Patients with specific insurance plans: Certain insurance plans require prior authorization for certain medications or medical procedures. It is crucial to understand your insurance coverage and whether prior authorization is necessary for your specific situation.
2. Healthcare providers: Physicians, pharmacists, and other healthcare professionals who prescribe medications or recommend medical procedures may need to submit prior authorization requests on behalf of their patients. They need to follow the insurance company's guidelines and complete the necessary paperwork accurately.
3. Insurance companies: The insurance companies themselves review and process prior authorization requests. Their role is to assess the medical necessity of the requested medication or procedure and determine if it meets their coverage criteria.

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What is prior authorization request?

Prior authorization request is a process used by insurance companies to determine if they will cover certain prescribed medications or medical procedures.

Who is required to file prior authorization request?

Healthcare providers, hospitals, and sometimes patients are required to file prior authorization request.

How to fill out prior authorization request?

Prior authorization request forms can be filled out online, over the phone, or by submitting a paper form with all required information.

What is the purpose of prior authorization request?

The purpose of prior authorization request is to ensure that medical treatments or medications are necessary and appropriate before coverage is provided.

What information must be reported on prior authorization request?

Information such as patient's medical history, diagnosis, prescribed treatment, and healthcare provider's information must be reported on prior authorization request.