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Get Gateway Prior Auth Form
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How to fill out the Gateway Prior Auth Form online
Navigating the Gateway Prior Auth Form online can streamline your prior authorization process. This guide provides comprehensive step-by-step instructions to help you fill out the form accurately and efficiently.
Follow the steps to complete the Gateway Prior Auth Form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering member information in Section A. Fill in the first name, last name, date of birth, member ID, and any allergies. Provide the pharmacy name and the drug name requested along with the type of reaction(s) the member experiences.
- Proceed to Section B, which contains pharmacy information. Input the pharmacy phone number for contact regarding the medication.
- In Section C, provide clinical information. Fill out the dosage and frequency, quantity, length of therapy, and the diagnosis for which the drug is being requested. Indicate the date the medication was initiated and whether the patient is currently receiving the requested medication.
- You must document any therapeutic failures or contraindications to formulary products. List any formulary alternatives that have been used by the patient, including the drug name, strength, dates tried, and the reason for therapy failure or discontinuation.
- Next, indicate if the member is currently or recently hospitalized, along with their date of discharge if applicable.
- Provide any additional clinical or supporting information, such as office notes, lab data, and other medical literature that supports your request.
- Move to Section D and enter the prescriber information. Include the prescriber’s name (printed), specialty, office phone, contact person, signature, extension, NPI number, and office fax.
- Finally, review all entered information for accuracy. Once confirmed, you can save changes, download, print, or share the completed form as needed.
Complete the Gateway Prior Auth Form online today for a smooth authorization process.
To get a pre-auth, you must discuss the required procedure or medication with your healthcare provider, who will then submit the Gateway Prior Auth Form to your insurance company. Ensure all necessary documentation is included to facilitate quicker approval. Following up with your insurer can also help keep track of your request's status.
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