Get Mhcsi Form

Filling out the Mhcsi Form online can streamline the process of obtaining prior authorization for medical services. This guide provides clear instructions to ensure that users can complete the form accurately and efficiently.

Follow the steps to fill out the Mhcsi Form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information. This includes the patient's surname, first name, initial, and the employee name if the patient is not the employee. Also, input the group number, ID number, and the relationship to the employee (options include employee, spouse, or dependent). Don't forget to add the patient's date of birth.
3. Next, indicate whether there is coordination of benefits by selecting 'Yes' or 'No.' If you select 'Yes,' provide the name of the coordinating plan and, if applicable, the group number.
4. Fill in the patient's address, including street address, city, province, and postal code. Ensure to provide the patient's phone number accurately.
5. Proceed to the drug/diagnostic information section. Here, specify the medication requested, dosage/dosing interval, drug identification number (DIN), diagnosis/indication, quantity requested, anticipated duration of therapy, and therapeutic goals.
6. In the section for supporting requirements for the requested medication, provide details of any previous treatments, including medications tried and their outcomes. Indicate the relevant option (e.g., contraindication, adverse effect) and explain as needed.
7. If applicable, include results of any supporting lab tests or other testing that validate the necessity for the medication.
8. Next, address any alternative baseline therapies that are not an option by selecting from the listed reasons (e.g., contraindication, allergy) and providing an explanation.
9. Have the physician or nurse practitioner print and complete their name, sign, and date the form. If a pharmacist is involved, their name and signature should be recorded as well.
10. Lastly, check the office use section. This will be completed by the MHCSI team, but ensure that all sections are filled out correctly to avoid delays. Save your changes, and then download, print, or share the form as necessary.

Complete the Mhcsi Form online today to ensure timely processing of your prior authorization request.