Get Prior Authorization Form - Magellan Health Services Tenncare ...

Filling out the Prior Authorization Form for Magellan Health Services TennCare can be a straightforward process when you follow clear guidelines. This guide provides a step-by-step approach to help you accurately complete the form online and ensure timely processing of your request.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to access the Prior Authorization Form and open it in your preferred editor.
2. Provide the member information by filling in the last name, first name, ID number, and date of birth in the respective fields.
3. Enter the prescriber information, including the prescriber's last name, first name, NPI number, DEA number, phone number, and fax number.
4. Complete the requested general/non-preferred drug section by specifying the medication name, strength, directions for use, and if applicable, indicate if it is a compound medication.
5. Answer whether the patient may use the generic equivalent if available by selecting 'Yes' or 'No.' Also, specify if a backdated prior authorization is requested.
6. Indicate the duration of therapy requested along with the requested prior authorization date if applicable.
7. Provide clinical criteria documentation. This includes answering questions related to the diagnosis, any previous trials of preferred medications, adverse events, and current medication use.
8. Sign the form to confirm that all information provided is accurate. Ensure the prescriber’s signature is included, as it is required for processing.
9. Finally, fax the completed form to 1-866-434-5523 or mail it to the TennCare Pharmacy Program at the specified address. Be sure to keep a copy for your records.

Complete your documents online for a smoother approval process.