Follow the steps to fill out the Paramount Pre Auth Form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin filling in the member's information, including their full name and date of request. Make sure to include both the Paramount Member ID Number and date of birth accurately.
3. Next, enter the prescriber's name and provide their signature. Additionally, fill out the provider's address, Paramount Provider ID, phone number, fax number, and a contact name.
4. In the dosage/frequency requested section, specify the requested dosage and frequency. Remember, the quantity limit is 102 tablets per prescription.
5. Indicate the reason for the request by selecting one of the checkboxes provided for either 'treatment of pain' or 'treatment of addiction'.
6. Answer the questions regarding the patient's use of other opiates and their participation in a counseling or treatment program by checking 'yes' or 'no' accordingly.
7. If you are requesting an initial authorization, note that it will be granted for up to six months. For extensions, clinical notes must be provided to support ongoing treatment plans.
8. In the clinical notes section, provide detailed information that supports the request for extended treatment, including any relevant therapy plans, attempts at dose reduction, and evidence of patient progression or relapse.
9. Review all entered information for accuracy. Once you have verified that everything is correct, you can save changes, download, print, or share the form as needed.

Complete your Paramount Pre Auth Form online today for efficient processing.