Get 18662496155

Filling out the 18662496155 form is an essential step in requesting prior authorization for certain medications. This comprehensive guide will walk you through the necessary steps to complete the form accurately and efficiently, ensuring all required information is submitted to CVS Caremark for processing.

Follow the steps to complete the 18662496155 form successfully

1. Click the ‘Get Form’ button to obtain the 18662496155 form and open it in your preferred editor.
2. Begin by entering the patient’s name in the designated field. Ensure accuracy, as this will be used for identification.
3. Input the date of completion in the provided space. This should reflect the current date.
4. Fill in the patient’s ID and date of birth. These details are crucial for verifying the patient’s eligibility.
5. Provide the physician’s name, specialty, and National Provider Identifier (NPI) number in the respective fields. This establishes the medical authority behind the prescription.
6. Enter the physician’s office telephone and fax numbers to facilitate communication with CVS Caremark.
7. Complete the physician's office address to ensure proper routing of correspondence.
8. Indicate which drug is being prescribed by selecting the appropriate option: Vivaglobin, , or specify another.
9. State the diagnosis by selecting the specific condition that applies or providing any additional information relevant.
10. Fill in the ICD9 code that corresponds to the diagnosis; this is necessary for accurate medical coding.
11. Indicate the patient’s age in years using the allotted space.
12. Assess and mark any contraindications the patient has regarding intravenous immune globulin use, or choose 'None of the Above' if none apply.
13. Answer whether subcutaneous immune globulin will be administered outside of a controlled healthcare setting. Provide detail as appropriate.
14. Confirm if an appropriate treatment kit is available for managing acute hypersensitivity reactions by selecting yes or no.
15. After completing all fields, ensure to review all entries for accuracy. Once confirmed, print or save the document as needed.
16. Finally, fax the completed form to CVS Caremark at 1-866-249-6155, or choose to share it securely as preferred.

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