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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. Start by obtaining the prior authorization request form from your healthcare provider, insurance company, or the appropriate online platform.
2. Carefully read through the instructions and form requirements to ensure you understand what information needs to be provided.
3. Begin by filling out your personal information, including your name, date of birth, address, and contact details.
4. Provide your insurance information, such as policy number, group number, and the name of the insurance company.
5. Next, include the specific details of the requested service or medication that requires prior authorization. This may include the name, dosage, quantity, and duration of the treatment.
6. Attach any supporting documents that may be required, such as medical records, test results, or physician's notes that explain the necessity of the requested service or medication.
7. Review the completed prior authorization form to ensure all the necessary fields are filled out accurately and completely.
8. If required, have your healthcare provider review and sign the form to indicate their support and engagement in the prior authorization process.
9. Make a copy of the filled-out form for your records and keep it together with any supporting documentation you have attached.
10. Follow the submission instructions provided on the form, whether it is mailing it to the designated address, faxing it to the appropriate number, or submitting it electronically through the given online platform.

Who Needs a Prior Authorization Request?

1. Prior authorization requests are typically needed when a healthcare service, treatment, or medication is not automatically covered by an insurance policy.
2. Insurance companies use prior authorization as a means to ensure the medical necessity and appropriateness of the requested service or medication.
3. It is essential for patients, healthcare providers, and pharmacists to initiate a prior authorization request to avoid unexpected denials, delays, or out-of-pocket expenses.
4. Healthcare providers usually need to request prior authorization for specialized treatments, surgeries, diagnostic tests, certain medications, or referrals to specialists that may fall outside the standard coverage guidelines.
5. Patients often need prior authorization for specific prescription drugs that require review and approval by the insurance company before coverage is provided.
6. It is essential to check the insurance policy terms, coverage limitations, and the list of services or medications that require prior authorization to understand when and for whom it is necessary.
7. Patients and healthcare providers can consult the insurance company's website, customer service representatives, or their healthcare network for more specific information about prior authorization requirements.

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What is prior authorization request?

Prior authorization request is a process by which a healthcare provider obtains approval from a health insurance plan before providing a certain treatment or procedure.

Who is required to file prior authorization request?

Healthcare providers are required to file the prior authorization request.

How to fill out prior authorization request?

Prior authorization requests can be filled out online, by phone, or by submitting a paper form to the insurance company.

What is the purpose of prior authorization request?

The purpose of prior authorization request is to ensure that the treatment or procedure being requested is medically necessary and will be covered by the insurance plan.

What information must be reported on prior authorization request?

Information that must be reported on prior authorization request includes patient information, healthcare provider information, diagnosis codes, treatment codes, and supporting documentation.