Get Pa02 - Cns Stimulants Not Required For Recipients Under 21 - Eohhs Ri

Filling out the PA02 form is an essential step in requesting prior authorization for CNS stimulant medications for users under the age of 21. This comprehensive guide provides clear, step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to effectively complete the PA02 form online.

1. Press the ‘Get Form’ button to access the PA02 form and open it in your preferred document editor.
2. Begin filling out the client information section by entering the client name, date of birth, and Medicaid ID number.
3. Complete the prescriber details by entering the prescriber name, NPI number, office address, phone, and fax numbers.
4. In the drug requested section, specify the medication name and the quantity to be filled. Remember that no refills are allowed.
5. Indicate the relevant diagnosis by marking the appropriate checkbox and entering the corresponding ICD10 code for each diagnosis listed. Ensure to include any additional diagnoses in the 'Other' section.
6. In the comments section, provide any additional information pertinent to the request that may help in the approval process.
7. Finally, the prescriber must sign and date the form, confirming the accuracy of the information provided.
8. Once completed, save the changes, and you can choose to download, print, or share the form as necessary.

Complete your PA02 form online today to ensure timely processing of your prior authorization request.