Get Prior Authorization Form - Magellan Pharmacy Solutions

This guide provides a comprehensive walkthrough on how to fill out the Prior Authorization Form for Magellan Pharmacy Solutions online. By following these steps, you can ensure that all necessary information is accurately submitted to facilitate the prior authorization process.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the Prior Authorization Form and open it in your selected editor.
2. Fill in the prescriber's information. Enter the prescriber's name, NPI number, and phone number in the designated fields. Make sure that all data is accurate to avoid delays.
3. Next, provide detailed patient information including the patient's name, member ID, date of birth, sex, and phone number. Ensure that each field is filled out completely.
4. Indicate who from the prescriber's office is completing the form by filling in their name, along with the pharmacy provider details if available, including the pharmacy's phone and fax numbers.
5. In the section ‘Prior Authorization Requested For’, select the appropriate authorization type by checking the corresponding box for the medication request, quantity limit exception, or other specifications.
6. Input the requested drug's name, dose, strength, and length of therapy in the respective fields to specify the medication required for the patient.
7. Provide the diagnosis in detail, as this information supports the request. Be thorough in your explanation to justify the need for the medication.
8. List any previous medications that have been attempted, noting the dates and outcomes for each. This history is critical for the prior authorization process.
9. Include any additional medical justification for the requested medication in the space provided to strengthen the request.
10. Lastly, the prescriber must sign the form, indicating their specialty. After completing the form, review all entries for accuracy.
11. Once you have confirmed that all information is correct, you can save changes, download the completed form, and print or share it as required.

Complete your Prior Authorization Form online to facilitate your medication request process.