Get Catamaran North Carolina Prior Auth Form

Filling out the Catamaran North Carolina Prior Auth Form online is an essential step in obtaining prior authorization for proton pump inhibitors. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access the Catamaran North Carolina Prior Auth Form and open it in your preferred editing tool.
2. Begin by filling out the member information section. Include the member's last name, first name, ID number, and date of birth.
3. Next, complete the prescriber information section. Provide the prescriber's last name, first name, NPI number, DEA number, phone number, and fax number.
4. In the requested proton pump inhibitor section, select whether the medication is preferred or non-preferred and specify the exact medication requested.
5. Indicate the strength of the medication, provide specific directions for use, and answer whether a request to backdate the prior authorization is necessary, including the requested start date if applicable.
6. Fill out the clinical criteria documentation. Answer any questions regarding previous medications, including any preferred drugs the patient has failed.
7. If applicable, complete the additional questions if requesting lansoprazole ODT or Prevacid SoluTab, including the patient's ability to swallow oral medications.
8. Final sections include detailed information on dose frequency and recent medication history. Gather all relevant information regarding the patient's medication use and outcomes.
9. Once all sections are complete, ensure to include the prescriber’s signature and the date in the designated areas.
10. Review the completed form for accuracy and clarity. Save any changes, then download, print, or share the form as needed.

Complete your Catamaran North Carolina Prior Auth Form online to ensure a smooth and timely authorization process.