Get () Prior Authorization Of Benefits (pab) Form - Anthem

Filling out the Prior Authorization Of Benefits (PAB) Form for Anthem is a crucial step in ensuring that patients receive the necessary medication they require. This guide provides clear instructions on how to effectively complete the form online, ensuring all critical information is submitted accurately.

Follow the steps to complete the form properly.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Provide patient information in section 1. Include the patient's name, ID number, date of birth, phone number, and email address to ensure clear identification.
3. In section 2, fill out the prescribing physician’s information. Include their name, address, phone number, fax number, specialty, DEA, and NPI numbers.
4. Detail the medication prescribed in section 3, identifying it as () along with the strength in section 4, specifying either 20mg or another dosage as applicable.
5. Explain the treatment directions for the medication in section 5 and indicate the quantity needed per 30 days in section 6.
6. In section 7, provide a clear diagnosis that warrants the use of the medication. Be specific and thorough.
7. Section 8 requires you to check all applicable approval criteria regarding the patient's treatment history and condition. Ensure that all relevant boxes are checked to avoid complications in the approval process.
8. Finally, have the prescribing physician sign and date in section 9 to validate the request.
9. Once all sections are completed, review the entire form for accuracy, save any changes, and be prepared to fax the completed form to the Prior Authorization of Benefits Center.

Start your Prior Authorization Of Benefits (PAB) Form - Anthem process online today.