Get Tricare Authorization Form

Filling out the Tricare Authorization Form online is a critical step in securing necessary medications and treatments. This guide provides clear and detailed instructions to help you successfully complete the form, ensuring that you submit all required information effectively.

Follow the steps to fill out the Tricare Authorization Form online.

1. Click ‘Get Form’ button to access the Tricare Authorization Form and open it in your preferred document editor.
2. Begin by entering the member's name and date of birth in the designated fields to identify the individual needing authorization.
3. Fill in the provider's name, office address, and contact information to ensure communication regarding the authorization.
4. Indicate the urgency of the request by checking either 'Urgent' or 'Non-urgent' as applicable.
5. Enter the member number and gender, ensuring this information is accurate for proper processing.
6. Provide the provider's phone number, fax number, and NPI number for verification and follow-up.
7. Specify the member’s primary care provider (PCP) to streamline patient care and coordination.
8. Clearly state the medication and requested dose, detailing the specific regimen as required for review.
9. Complete the required criteria section, confirming the diagnosis and previous medication history to support the authorization request.
10. If required, check the additional Medicare options that may apply, based on the member's unique circumstances.
11. Review the entire form for completeness and legibility; ensure all fields are filled accurately.
12. Once completed, save your changes, then download, print, or share the form as needed, and fax it to the provided numbers.

Start filling out your Tricare Authorization Form online today for efficient processing!