Get Express Scripts Prior Auth Form
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How to fill out the Express Scripts Prior Auth Form online
The Express Scripts Prior Authorization of Benefits form is essential for obtaining coverage for medications like and . This guide will provide you with clear instructions to successfully complete the form online.
Follow the steps to complete the form effectively.
- Press the ‘Get Form’ button to obtain the document and open it for editing.
- Begin with the Patient Information section. Fill in the patient's full name, date of birth, phone number, and email address. Ensure that the Patient ID number is included.
- Proceed to the Physician Information section. Provide the prescribing physician's name, address, phone number, fax number, specialty, DEA number, and NPI number. Complete both Physician Email and Phone fields.
- In the Medication section, select either or by marking the corresponding box. Specify the required strength and dosage.
- Complete the Directions and Quantity Per 30 Days fields to indicate how the medication should be administered and the expected quantity needed.
- Fill out the Diagnosis section, providing a detailed account of the patient's condition relevant to the medication request.
- Address the Approval Criteria by checking all applicable boxes. Ensure to answer all questions comprehensively, especially with regard to previous treatments and patient conditions.
- Sign the form in the Physician Signature section, including the date of submission.
- Once completed, you can save changes, download the form, print it, or share it as needed. Ensure that the completed form is securely submitted to the Prior Authorization of Benefits Center.
Complete the Express Scripts Prior Auth Form online today for timely access to necessary medications.
Completing a prior authorization involves several straightforward steps. Begin by obtaining the Express Scripts Prior Auth Form, which you can find on their website or through your healthcare provider. Fill in the required patient details, medication information, and medical necessity justifications clearly. Submitting the form promptly ensures that your request is processed in a timely manner, minimizing any delays in receiving your medication.
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