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Prior Authorization, Pharmacy and Health Case Management Information The purpose of this information sheet is to provide you with details on how The Greatest Life will be assessing and managing your claim
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How to fill out icatibant acetate - Great-West:

01
Obtain the necessary forms and documentation for filing an icatibant acetate claim with Great-West.
02
Fill in the required personal information, such as your name, address, and contact details, on the claim form provided by Great-West.
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Provide your insurance information, including your policy number and any other relevant details that may be requested.
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Indicate the treatment details by specifying the medication name (icatibant acetate), dosage, frequency, and duration of treatment.
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Include the prescribing healthcare provider's information, such as their name, address, and contact details.
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Attach any supporting documentation required, such as a prescription from your healthcare provider or copies of medical records.
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Review the completed form for accuracy and make sure all sections are properly filled out.
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Submit the filled-out icatibant acetate claim form and any supporting documents to Great-West as per their specific instructions.

Who needs icatibant acetate - Great-West?

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Patients suffering from hereditary angioedema (HAE), a genetic disorder characterized by severe swelling attacks in various body parts.
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Individuals with HAE who experience recurrent episodes of swelling in the face, extremities, or airways, leading to discomfort, pain, and potential life-threatening situations.
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Patients with a prescription for icatibant acetate from their healthcare provider and coverage under Great-West insurance, as determined by their policy.
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Icatibant acetate - great-west is a medication used to treat hereditary angioedema (HAE) attacks.
Healthcare providers or pharmacies may be required to file icatibant acetate - great-west for reimbursement purposes.
To fill out icatibant acetate - great-west, you will need to provide information on the patient, the prescribing healthcare provider, and details of the medication administration.
The purpose of icatibant acetate - great-west is to provide treatment for acute HAE attacks.
Information such as the patient's name, date of birth, diagnosis, prescription details, and healthcare provider information must be reported on icatibant acetate - great-west.
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