Get Ppi Pa Form - Magellan Health Services Tenncare Portal
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How to fill out the PPI PA Form - Magellan Health Services TennCare Portal online
This guide provides a step-by-step approach to completing the PPI PA Form for Magellan Health Services through the TennCare Portal. Ensuring that the form is filled accurately is crucial to avoid delays in the prior authorization process.
Follow the steps to successfully complete your form online.
- Click 'Get Form' button to access the PPI PA Form and open it in the editing tool.
- In the 'Member Information' section, fill out the last name, first name, ID number, and date of birth of the member requesting the proton pump inhibitor.
- Proceed to the 'Prescriber Information' section: input the prescriber’s last name, first name, NPI number, DEA number, phone number, and fax number.
- In the 'Requested Proton Pump Inhibitors' section, select either 'Preferred' or 'Non-Preferred' and list the strength and directions for the requested medication.
- Complete the 'Clinical Criteria Documentation' section: indicate the diagnosis, drug trials, and any adverse events related to preferred drugs.
- If the requested medication is lansoprazole ODT or Prevacid Solutabs, answer questions regarding the patient’s ability to swallow oral medications and their gastrointestinal absorption issues.
- If requesting twice daily dosing, respond to questions about uncontrolled symptoms and the duration of the once daily dosing.
- If requesting a renewal for twice daily dosing, indicate whether the patient has tried once daily dosing and its outcomes.
- Sign and date the form in the 'Prescriber Signature' section to confirm that all provided information is accurate.
- Finally, save your changes, and you may choose to download, print, or share the completed form as needed.
Complete your prior authorization forms online to ensure timely processing!
As of now, the CEO of Magellan Health is a key figure in leading the organization towards delivering innovative health solutions. Their leadership focuses on enhancing services like the PPI PA Form - Magellan Health Services TennCare Portal. This commitment to providing superior healthcare solutions reflects in their organizational strategies. For the latest updates, visit Magellan Health's official website for dynamic leadership information.
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