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Prior Authorization Request (For Maryland Only) Send completed form to: Case Review Unit CVS/earmark Specialty Programs Fax: 8662496155 CVS/earmark administers the prescription benefit plan for the

How to fill out prior authorization request

How to fill out a prior authorization request:

1. Gather all necessary information: Before filling out the prior authorization request, make sure you have all the required information handy. This includes the patient's personal details, insurance information, medication or treatment details, and any supporting documentation or medical records that may be required.
2. Contact the insurance company: Reach out to the patient's insurance company to obtain the correct prior authorization forms or to find out if they have an online portal where you can submit the request. Make note of any specific instructions or additional documentation required by the insurance company.
3. Complete the form accurately: Fill out the prior authorization request form carefully and accurately. Provide all requested information, such as the patient's name, date of birth, diagnosis, prescribed medication or treatment, dosage, frequency, and duration. Double-check the form for any errors or missing information before submission.
4. Include relevant medical documentation: Attach any relevant medical documentation that supports the need for the requested treatment or medication. This may include medical records, test results, physician's notes, and any other supporting evidence that demonstrates the medical necessity.
5. Submit the prior authorization request: After carefully reviewing and completing the form, submit the prior authorization request either online or by mail, following the insurance company's preferred method. If you choose to submit it via mail, consider sending it through certified mail with a return receipt to ensure it reaches its destination.
6. Keep a copy of the request: It is essential to maintain a copy of the submitted prior authorization request for your records. Make sure to document the date of submission and any tracking numbers if applicable.

Who needs prior authorization request?

1. Patients seeking coverage for specific medications or treatments: Prior authorization requests are typically required for certain medications, treatments, or procedures that insurers consider to be non-formulary or require additional scrutiny. Patients who need access to these medications or treatments will require a prior authorization request.
2. Healthcare providers: Healthcare providers, including physicians, specialists, and medical facilities, need prior authorization for procedures or medications they prescribe or recommend that fall under a payer's prior authorization requirements. They are responsible for completing and submitting the prior authorization request on behalf of their patients.
3. Insurance companies: Insurance companies play a pivotal role in the prior authorization process. They review the submitted requests to determine if the requested medication or treatment meets the coverage criteria and medical necessity guidelines outlined in the patient's insurance policy.

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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 a prescribed medical treatment or medication.

Who is required to file prior authorization request?

Healthcare providers are typically required to file prior authorization requests on behalf of their patients.

How to fill out prior authorization request?

Prior authorization requests can be filled out online, by phone, or through fax using the required forms provided by the insurance company.

What is the purpose of prior authorization request?

The purpose of prior authorization request is to control costs and ensure that treatments or medications are medically necessary before they are approved for coverage.

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.