Get & - Iu Health Plans

Filling out the & - IU Health Plans form is essential for obtaining prior authorization for medications. This guide provides step-by-step instructions to help you complete the form accurately and efficiently, ensuring that you have all necessary details ready.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to obtain the form and open it in your document management system.
2. Begin filling out the 'Patient Information' section. Enter the patient's name, date of birth (DOB), age, and health plan ID.
3. Proceed to the 'Prescriber Information' section. Fill in the prescriber’s name, NPI number, pharmacy name, pharmacy phone number, specialty, and office contact details.
4. In the 'Medication Information' section, select the relevant medication - either or . Indicate whether this is a new medication or a continuation of therapy and provide the start date and directions.
5. Specify the quantity dispensed and day supply. If continuing therapy, ensure to provide chart documentation that shows the member showed improvement while on therapy.
6. Complete the 'Clinical Information' section by detailing the diagnosis, the date diagnosed, and answering questions about DEA certification, benzodiazepine use, controlled medications, and submitting relevant documentation.
7. Make sure to also answer the initial authorization and reauthorization requests if applicable. Provide required documentation for those as specified in the form.
8. Finally, review all entered information for accuracy, save any changes made, and choose to download, print, or share the completed form as needed.

Complete the & - IU Health Plans form online to ensure timely processing of your authorization request.