Get Anthem Prior Auth Request For Form

Completing the Anthem Prior Auth Request For Form online is a crucial step in ensuring necessary healthcare services are authorized in a timely manner. This guide provides clear, step-by-step instructions tailored to help users navigate the form effectively.

Follow the steps to accurately fill out the form.

1. Press the ‘Get Form’ button to download the Anthem Prior Auth Request For Form and open it in your preferred editor.
2. Begin by entering the request date in the designated space. Make sure to select ‘Initial Request’ or ‘Subsequent Request’ as applicable.
3. In the next section, specify where the medication should be shipped. Choose from options like 'MD Office,' 'Member’s Home,' or 'Other,' and provide details if necessary.
4. Provide the member's personal information, including their full name, date of birth, phone number, and insurance identification number.
5. Input the primary diagnosis along with the ICD-9 code if known.
6. Fill in the ordering provider's details, including their name, specialty, provider ID number (if known), office address, contact name, office phone number, and fax number.
7. If there is a servicing provider different from the ordering provider, complete the respective fields with their information.
8. Indicate the place of service by selecting from the provided options such as ‘Home,’ ‘Office,’ or ‘Outpatient Hospital.’
9. Enter the dose to be administered, including the drug name and HCPCS code if known.
10. Specify when the member first started this drug and provide the frequency of administration as well as the duration.
11. Check all applicable boxes regarding the member's conditions and circumstances to prevent delays in the review process.
12. Indicate if the request is being submitted pre-claim or post-claim and provide the claim number if applicable.
13. Finally, the provider or their representative must fill in their name, title, and the date of completion, attesting to the accuracy of the information provided.
14. Upon completion of the form, users can save the changes, download a copy, print the document, or share it as needed.

Complete your Anthem Prior Auth Request For Form online today to ensure prompt healthcare service.