Get Florida Blue Prior Authorization Form

Filling out the Florida Blue Prior Authorization Form online can streamline the process of obtaining necessary approvals for medical treatments. This guide will walk you through each section of the form, ensuring that you can provide the required information accurately and efficiently.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the today's date in the designated field at the top of the form.
3. In the patient information section, input the patient's first name, last name, middle initial, date of birth (formatted as mm/dd/yy), and the patient's telephone number.
4. Move to the health plan information section and fill in the Blue Cross ID number along with the group number for the patient's health plan.
5. In the physician/clinic information section, provide the prescriber's name, NPI number, specialty, clinic name, clinic address, city, state, and zip code, along with the phone number and contact name of the prescriber.
6. Include the secure fax number for your clinic to ensure confidentiality in communication.
7. Attach any additional documents that should be considered with this request as specified in the instructions.
8. Fill in the patient's diagnosis by including the ICD-9 code along with a brief description.
9. Provide the medication requested, including its strength, dosing schedule, and the quantity per month.
10. Answer the yes/no question regarding whether the patient is currently treated with the requested medication, and specify the date the treatment started if applicable.
11. List all reasons for selecting the requested medication over alternatives, indicating any contraindications, allergies, or previous adverse drug reactions.
12. Clarify reasons for choosing the specified strength, dosing schedule, and quantity, especially if alternatives were tried before.
13. Detail all medications the patient has previously tried and failed for the treatment of this diagnosis, specifying if they were brand-name or generic products.
14. Outline any other medications the patient will be using in combination with the requested medication for this diagnosis.
15. If the medication requested is a triptan, indicate whether the patient has been evaluated for chronic daily headache caused by medication overuse.
16. Once all sections are complete, review the form for accuracy and completeness before proceeding to save changes, download, print, or share the form as needed.

Complete the Florida Blue Prior Authorization Form online today to ensure prompt processing of your request.