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What is Prior Authorization Form
The Great-West Life Prior Authorization Form is a medical consent document used by patients and physicians to request approval for coverage of specific prescription drugs like Eylea.
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Prior Authorization Form is needed by:
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Plan Members seeking drug coverage approval
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Physicians prescribing medications requiring prior authorization
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Healthcare providers involved in patient treatment plans
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Pharmacists verifying prescription claims
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Insurance professionals handling drug claims
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Case management staff in healthcare settings
How to fill out the Prior Authorization Form
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1.Begin by accessing the Great-West Life Prior Authorization Form on pdfFiller. Use a search engine or navigate to the pdfFiller website, and enter the form name in the search bar.
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2.Once the form is open, familiarize yourself with the layout. Use the toolbar options to zoom in for easier reading or print the form if needed for reference.
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3.Gather all necessary information before completing the form. This includes the patient’s personal information, health plan details, and information on the prescribed medication.
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4.Start filling in the 'Plan Member Information' section. Type in the patient’s full name, plan number, and contact details using the fillable fields provided.
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5.Next, move to the 'Physician Information' section. Ensure the prescribing physician enters their name, contact information, and any relevant medical details required for the authorization request.
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6.Complete the 'Request for Information' section carefully. This includes detailing the diagnosis, prescribed dosage, treatment duration, and medical rationale supporting the need for the drug.
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7.If applicable, include sections for off-label use or coordination of benefits. Review any instructions prompting you to complete specific parts of the form.
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8.After filling out the form, review all provided information for accuracy. Use pdfFiller’s 'Preview' function to see how the completed form will look.
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9.Finalize the document, making sure that both the patient and physician have signed where required, following the completion instructions.
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10.Save or download the finished form by selecting the save option on pdfFiller. You can also directly submit it through the platform if the submission method is available.
Who is eligible to use the Great-West Life Prior Authorization Form?
Any patient prescribed a medication requiring prior authorization from Great-West Life can use this form, along with their physician to provide necessary medical details.
What is the process for submitting the form?
The completed Great-West Life Prior Authorization Form must be submitted to Great-West Life via mail, fax, or through your healthcare provider, as specified by their submission guidelines.
What supporting documents are needed when submitting the form?
Typically, supporting documents include a prescription from the physician and any relevant medical records that justify the need for the prescribed medication.
How long does it take to process the Great-West Life Prior Authorization Form?
Processing times can vary. Generally, you can expect to receive a response within 5 to 10 business days; however, urgent requests may be expedited.
What common mistakes should I avoid when filling out the form?
Common errors to avoid include omitting required signatures, providing incomplete information, and failing to include necessary medical rationale or supporting documents.
Are there any fees associated with submitting the prior authorization request?
There are typically no fees for submitting the Great-West Life Prior Authorization Form directly. However, check with your healthcare provider or insurance plan for any specific policies.
How can I securely submit my completed form?
You can submit the completed form securely via the designated fax number or mailing address provided by Great-West Life. Ensure that all sensitive information is handled securely.
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