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  • Florida Blue Prior Authorization Form Pdf

Get Florida Blue Prior Authorization Form Pdf

3. Send completed Form & Pharmacy receipts to: PRIME THERAPEUTICS, LLC; P.O. Box 25136; Lehigh Valley, PA 18002-5136 I. POLICY HOLDER INFORMATION POLICY HOLDER NAME (LAST, FIRST, MIDDLE) MEMBER ID NUMBER H GROUP NUMBER DATE OF BIRTH (MM/DD/YYYY) STREET ADDRESS SEX MALE FEMALE CITY, STATE, ZIP CODE II. PATIENT INFORMATION (Must be completed if patient is a dependent child or spouse.) DATE OF BIRTH (MM/DD/YYYY) PATIENT NAME (LAST, FIRST, MIDDLE) ADDRESS.

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Contact support

Call the Customer Service number on your member ID card or 1-800-FLA-BLUE (352-2583), Monday through Thursday 8 a.m. to 9 p.m. and Friday 9 a.m. to 9 p.m. You can easily access your health and pharmacy benefits, eligibility and claims information, automatically over the phone using your keypad.

Your doctor must contact Florida Blue at 1-877-719-2583 or its delegate at (800) 424-4947 at MagellanRx Management.

Why does my health insurance company need a prior authorization? The prior authorization process gives your health insurance company a chance to review how necessary a medical treatment or medication may be in treating your condition. For example, some brand-name medications are very costly.

You are solely responsible for getting any required authorization before services are rendered, regardless of whether you go to an in- or out-of-network health care provider. An in-network health care provider will request a prior authorization on your behalf.

About Florida Blue Florida Blue is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit .FloridaBlue.com.

Your doctor must contact SMS at 1-855-243-3326. You can also check the status of your authorization by contacting the phone number on the back of your ID card.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.

Most Blue Cross Blue Shield members can rest easy since Blue Cross Blue Shield coverage opens doors in all 50 states and is accepted by over 90 percent of doctors and specialists.

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© Copyright 1997-2025
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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