Get Myriad Genetics Prior Authorization

This guide provides a clear and supportive approach to completing the Myriad Genetics Prior Authorization form online. By following these steps, users can ensure a smooth submission process and facilitate timely review.

Follow the steps to complete the Prior Authorization form effectively.

1. Press the ‘Get Form’ button to access the Prior Authorization form and open it in your preferred editor.
2. Begin filling out Section 1: Identify the ordering physician by providing the member's name, ID, address, phone number, date of birth, gender, and physician's information including name, NPI number, and phone number.
3. In Section 2, provide general information about the laboratory including its name, phone number, specimen collection date, and the ICD-10 code(s) if applicable.
4. Move to Section 3: Select the appropriate test(s) from the menu, specifying any individual tests as necessary, such as BRCA 1 and BRCA 2 gene sequencing or BART testing for Medicare members.
5. In Section 4, outline the personal cancer history, including details of any breast, ovarian, or pancreatic cancer the patient has experienced, along with age and date of diagnosis.
6. Proceed to Section 5 to document any previous BRCA genetic testing history, noting results, testing lab, and dates of testing.
7. In Section 6, complete the family cancer history and ethnicity, detailing known family history concerning breast, ovarian, or pancreatic cancer, and ethnic background.
8. Review the Risk criteria categories outlined in Sections 7 and 8, marking any applicable risk for females and males, and including relevant diagnosis dates.
9. In Section 9, indicate medical management options in case of a positive test, such as prophylactic surgery or increased surveillance.
10. Complete Section 10 by noting the patient's education provided before testing, ensuring informed consent is confirmed.
11. In Section 11, read and acknowledge the important information regarding fraudulent filings.
12. Finally, sign the form in Section 12, providing your title, printing your name, and including contact information as required. Review all entries for completeness.
13. Once finished, save your changes, download or print the form to submit it along with any required medical documentation to the provided fax numbers.

Complete the Myriad Genetics Prior Authorization form online now to ensure prompt processing.