Get Medication Prior Authorization Request Form - Meridianrx

Filling out the Medication Prior Authorization Request Form - MeridianRx online is a crucial step in ensuring that your medication is authorized for coverage. This guide provides step-by-step instructions to help users navigate the form effectively.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access and open the Medication Prior Authorization Request Form for editing.
2. Begin with the 'Date of Request' section. Enter the specific date you are submitting the request.
3. In the 'Patient Information' section, fill in the patient's name, member ID number, date of birth, and contact information.
4. Provide the prescriber's details in the 'Prescriber Information' section, including their name, specialty, NPI number, and office phone and fax numbers.
5. Indicate the patient's sex by selecting the appropriate checkbox for male or female.
6. In the 'Diagnosis and Medical Information' section, enter the medication name, strength, route of administration, frequency of use, height, weight, BMI, expected length of therapy, and quantity.
7. Document the blood pressure reading and the date it was taken.
8. Outline the diagnosis related to the medication request and list any drug allergies the patient has.
9. In the 'Rationale for Prior Authorization' section, provide a detailed history of relevant medical conditions, allergies, or information necessitating the medication. Include previous medications tried and reasons for their failure.
10. Ensure that you have attached the most recent relevant laboratory results to complement the prior authorization review.
11. Finish by having the prescriber sign the form and include the date of their signature.
12. Once all sections are completed and reviewed for accuracy, save the document, and use the fax number provided to send the form.

Complete your Medication Prior Authorization Request Form online today for streamlined processing.