Get Prior Authorization Form - Priority Health

Completing the Prior Authorization Form for Priority Health is a crucial process that ensures you receive necessary medications without delay. This guide provides clear, step-by-step instructions to help you navigate the online form efficiently.

Follow the steps to successfully complete the Prior Authorization Form.

1. Press the ‘Get Form’ button to access the Prior Authorization Form online and open it for editing.
2. Begin filling out the member information section, which includes the member's last name, first name, ID number, date of birth, and primary care physician details.
3. Provide accurate details of the requesting provider. This includes their name, address, national provider identifier (NPI), phone number, fax number, signature, and date.
4. Fill in the contact name and specialty of the requesting physician, such as rheumatologist.
5. Indicate the type of request: new or continuation, and select the appropriate drug product, such as , along with the start date of treatment and date of last dose.
6. Answer the prior authorization criteria questions relevant to the patient's diagnosis, including confirmation of trials for medications like DMARDs or NSAIDs, and document the results of the annual TB test.
7. Complete the additional information section as needed, specifying the dose and duration of authorization related to specific conditions.
8. If applicable, state whether an exception request is necessary and provide a rationale for any waivers sought.
9. Review all fields to ensure they are complete and legible. After filling out the form, you may choose to save changes, download, print, or share the form as needed.

Complete your Prior Authorization Form online today to ensure timely access to your medication.