Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to access the Printable Exceptions Forms and open it in your preferred editor.
2. Begin filling out the personal details of the provider, including their first and last name, phone number, and fax number. Ensuring accuracy in this section is crucial for communication purposes.
3. Next, provide the patient’s information such as name, UPMC Health Plan ID number, date of birth, and age. This data is important for identifying the individual associated with the request.
4. In the drug requested section, clearly indicate the strength and frequency of the medication being requested. This must be complete to avoid delays in the processing of the request.
5. Select whether the medication is new or ongoing, and if it is ongoing, provide the start date and any indications of improvement during therapy.
6. Specify the place of administration for the requested medication, choosing between a physician’s office or a hospital/facility. Provide the name and address of the facility if necessary.
7. Indicate how the medication will be billed by selecting the appropriate option. If billing directly by the provider via JCODE, be sure to provide the JCODE.
8. Complete the medical history section by answering if is being used for skeletal-related events and if the member is currently on . Details regarding the type of cancer and previously tried medications should also be adequately filled out.
9. Finally, provide any additional information that may support the request in the space provided.
10. Once all sections are filled in, review the form to ensure all information is correct. You can save changes, download, print, or share the form as needed.

Start filling out your Printable Exceptions Forms online today to ensure timely access to your needed medications.