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DEPARTMENT OF HEALTH SERVICES Division of Health Care Access and Accountability F01247 (10/14) STATE OF WISCONSIN DHS 107.10(2), Wis. Admin. Code FORWARDHEALTH PRIOR AUTHORIZATION DRUG ATTACHMENT

How to fill out prior authorization drug attachment

How to fill out prior authorization drug attachment:

1. Ensure that you have the necessary form: Prior authorization drug attachment forms can usually be obtained from your healthcare provider or insurance company. Contact them to request the specific form needed for your medication.
2. Gather all the required information: Before starting to fill out the form, make sure you have all the necessary information on hand. This may include details such as your personal information, healthcare provider's information, medication name, dosage, and any supporting documentation or medical records.
3. Read the instructions carefully: Prior authorization forms can vary, so it's important to read the instructions provided with the form. These instructions will guide you on how to fill out each section accurately and completely.
4. Provide personal information: Begin by filling out your personal details, including your name, address, date of birth, and contact information. Some forms may also require your insurance policy or identification number.
5. Fill out healthcare provider's information: This section typically asks for your healthcare provider's name, address, phone number, and any additional identifying information. It's important to provide accurate and up-to-date information to ensure proper authorization.
6. Specify the medication: Enter the name of the medication that requires prior authorization. Include information on the dosage, frequency, and any other relevant details. If multiple medications need authorization, ensure that you provide separate sections for each one.
7. Provide supporting documentation: Depending on the medication and the insurance company's requirements, you may need to attach supporting documentation. This could include medical records, test results, or explanatory notes from your healthcare provider. Be sure to follow any specific instructions regarding the submission of documents.
8. Review and double-check: Once you have completed filling out the form, take a moment to review all the information entered. Ensure that everything is accurate, legible, and complete. Look for any missing sections or errors that need to be corrected.
9. Submit the form: After reviewing, sign and date the form as required. Make copies for your records and gather any additional documentation that needs to be included. Submit the form and supporting documents to your healthcare provider or insurance company as instructed.

Who needs prior authorization drug attachment?

1. Patients prescribed medications requiring prior authorization: If you have been prescribed a medication that requires prior authorization, you will need to complete the drug attachment form. This is typically requested when the medication is not on your insurance company's formulary or when certain criteria must be met before the medication is approved for coverage.
2. Healthcare providers: Healthcare providers, including doctors and other medical professionals, need the prior authorization drug attachment to facilitate the approval process for medication that their patients require. They must provide necessary information and supporting documentation to justify the need for the medication.
3. Insurance companies or pharmacy benefit managers: Insurance companies or pharmacy benefit managers require the prior authorization drug attachment to evaluate the medical necessity and appropriateness of the prescribed medication. They rely on this information to make decisions regarding coverage and to ensure cost-effective use of medications.

Overall, the prior authorization drug attachment form is an important tool that allows patients, healthcare providers, and insurance companies to work together to ensure the appropriate and timely authorization of medications.

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What is prior authorization drug attachment?

Prior authorization drug attachment is a process where healthcare providers must obtain approval from an insurance company before certain medications can be prescribed to a patient.

Who is required to file prior authorization drug attachment?

Healthcare providers, such as doctors and pharmacists, are required to file prior authorization drug attachments.

How to fill out prior authorization drug attachment?

Prior authorization drug attachments must be filled out with detailed information about the patient, prescribed medication, and the reason for the request.

What is the purpose of prior authorization drug attachment?

The purpose of prior authorization drug attachment is to ensure that patients receive appropriate and necessary medications while controlling costs for insurance companies.

What information must be reported on prior authorization drug attachment?

Information such as patient demographics, medical history, prescribed medication, dosage, and diagnosis must be reported on prior authorization drug attachments.