Get Florida Blue Prior Authorization Form

Completing the Florida Blue Prior Authorization Form online is an essential process for prescribers to ensure that patients receive the necessary medications in a timely manner. This guide provides step-by-step instructions to help users navigate the form effectively.

Follow the steps to successfully complete the Florida Blue Prior Authorization Form online.

1. Click 'Get Form' button to obtain the form and open it in your editor.
2. Begin by entering today's date in the designated field at the top of the form.
3. Fill out the patient information section. Include the patient's date of birth, first and last name, gender initial, address, city, state, zip code, and telephone number.
4. In the insurance information section, input the patient's insurance ID number and group number.
5. Complete the physician/clinic information, which includes the prescriber's name, NPI number, clinic name, specialty, contact name, clinic address, city, state, zip code, phone number, and secure fax number.
6. Attach any additional information required for the authorization request as instructed.
7. Provide the patient's diagnosis, including the ICD-9 code and a brief description.
8. List the medication requested along with its strength, dosing schedule, and quantity per month.
9. Articulate all reasons for selecting the requested medication over alternatives in the provided section.
10. Document any medications previously tried by the patient with details of brand-name or generic products processed.
11. Note any other medications the patient will use in combination with the requested treatment.
12. Indicate whether the prescribed dose exceeds the maximum recommended dose by marking 'Yes' or 'No.' If yes, provide supporting documentation.
13. Answer any additional questions regarding the patient's history with specific medications, ensuring you include thorough explanations where needed.
14. Once all sections are complete, review the information for accuracy before submitting.
15. Save changes, download, print, or share the completed form as required.

Complete and submit the Florida Blue Prior Authorization Form online today to ensure prompt processing of your request.