Get Request For Prior Authorization Of Medication Form Medco-31

Filling out the Request For Prior Authorization Of Medication Form MEDCO-31 can be a straightforward process when you approach it step by step. This guide will assist you in completing the form accurately and efficiently to ensure your request is processed without delay.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to access the form and open it in your online editor.
2. Begin by entering the injured worker information. Fill out the request date, BWC claim number, injured worker name, and injured worker date of injury. Ensure all fields are completed accurately.
3. Proceed to the prescriber information section. Input the prescriber’s name, NPI (National Provider Identifier), phone number, and fax number. This information is crucial for processing the request.
4. In the medication requested and conditions being treated section, list the medication name and the corresponding ICD code(s) along with their descriptions. You can enter up to four different codes as applicable.
5. Indicate whether the medication is a non-sterile compound, sterile compound pain pump, or sterile compound other. If applicable, select the option for the brand name drug and note any documented allergies.
6. If this request is post-surgical, fill in the date of the scheduled surgery to provide additional context for the authorization.
7. In the justification for request area, document how the requested medication relates to the treatment or control of symptoms associated with the conditions in the claim. You may need to attach a separate sheet if you require more space.
8. Lastly, ensure the prescriber signs the form and includes the signature date. This verifies the request and is a required step before submission.
9. Once the form is completed, you can save your changes, download a copy, print it for your records, or share it as needed.

Get started on completing the Request For Prior Authorization Of Medication Form MEDCO-31 online today.