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  • Ppi Pa Form - Magellan Health Services Tenncare Portal

Get Ppi Pa Form - Magellan Health Services Tenncare Portal

Prior Authorization Form Proton Pump Inhibitors Access this PA form at https://tenncare.magellanhealth.com/static/docs/Prior Authorization Forms/TennCare PPI PA Request Form.pdf If the following information.

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You may also request the form by mailing a letter to Division of TennCare, RFR Processing Unit, 310 Great Circle Road, 3rd Floor, Nashville, TN 37243 or a faxing a letter to (615) 413-1941. Follow all of the instructions on the Request for Release Form and transmit it to TennCare as directed on the form.

On the Coverage Overview page, click My Documents from the Left Navigation Menu to access the Documents We Need page. This page allows you to upload documents for an individual. You can also upload documents immediately after you submit an application, change, or renewal through TennCare Access.

Fax this form to: 1-800-424-3260 A fax cover sheet is not required.

To request prior authorization, please submit your request online or by phone. Prior authorization is not required for emergency or urgent care. Out-of-network physicians, facilities and other health care providers must request prior authorization for all procedures and services, excluding emergent or urgent care.

A Tennessee Medicaid Prior Authorization Form is a document used by medical offices in the State of Tennessee to request Medicaid coverage for a non-preferred drug. The person filling the form must provide medical justification as to why they are not prescribing a drug from the PDL (Preferred Drug List).

Magellan Rx's employer business clients cover Ozempic as a preferred brand for diabetes, and Wegovy is a nonpreferred brand for weight loss with prior authorization being required for both drugs. But not all clients opt to cover weight loss management and Wegovy, the spokesperson said.

Fax PA Requests For drug specific forms please see the Forms tab under Resources. Please alert the member that the above steps will take additional time to complete. If this is an urgent prescription, have the member call Magellan Customer Service at 800-424-3312.

TennCare has up to 45 days to process your application after you have turned in all the information they request. TennCare will make a determination. You will receive a notice in the mail stating whether your application was approved or denied.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232