Get 877 526 2307 Form

Completing the 877 526 2307 Form online for Medicare prescription drug coverage determination can seem complex. This guide provides clear and straightforward steps to assist you in filling out the form effectively and efficiently.

Follow the steps to successfully complete the 877 526 2307 Form online.

1. Press the ‘Get Form’ button to access the form and open it for completion.
2. Fill in the enrollee’s information, including their name, date of birth, address, phone number, and member ID number. Ensure accuracy in all details to avoid processing delays.
3. If the request is made by someone other than the enrollee or prescriber, complete the requestor’s information section. Provide their name, relationship to the enrollee, address, and phone number.
4. Attach any representation documentation if required, like the Authorization of Representation Form CMS-1696 or a written equivalent.
5. Specify the name of the prescription drug requested, including strength and monthly quantity if known.
6. Select the type of coverage determination request that applies. Options include needs for formulary exceptions, prior authorizations, and tiering exceptions, among others. Be sure to check the stipulation that requires a supporting statement from the prescriber if applicable.
7. If applicable, indicate if expedited decision is necessary by checking the relevant box and include the prescriber’s supporting statement.
8. Ensure that all required information is completed before signing the form. The signature must be from the enrollee, the enrollee’s prescriber, or a designated representative.
9. Complete the prescriber’s information, including their name, address, office phone, and fax number, and obtain their signature.
10. Review all entries for completeness and accuracy. Save your changes, download a copy for your records, and print the form if needed.

Complete your documents online today for a seamless submission process.