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

Filling out the Prior Authorization Form for Magellan Health Services is a crucial step in obtaining necessary medications. This guide will provide clear instructions on how to complete the form online to ensure you have a smooth and efficient submission process.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to access the Prior Authorization Form and open it in your preferred editor.
2. In the 'Member Information' section, fill in the required details including last name, first name, ID number, and date of birth. Ensure all information is complete and legible to avoid processing delays.
3. Next, provide 'Prescriber Information'. Enter the prescriber's last name, first name, NPI number, DEA number, phone number, and fax number as applicable.
4. In the 'Requested Atypical Antipsychotic' section, indicate the preferred or non-preferred medication, specify the dosage strength, and outline the directions for use.
5. If applicable, indicate whether a request to backdate the prior authorization is being made by selecting yes or no. Provide the requested PA date if yes.
6. Complete the 'Clinical Criteria Documentation' by selecting the diagnosis for which the medication is being requested and providing the relevant ICD-9 code.
7. Answer the questions regarding prior use of atypical antipsychotics and document any reasons for discontinuation if applicable.
8. In the final section, the prescriber must sign and date the form, confirming the accuracy of the information provided, and prepare the form for submission.
9. Once the form is fully completed and verified, you can save the changes, download the document, print it, or share it as needed.

Complete your Prior Authorization Form online today for timely processing.