Get Medicaid Prior Authorization Form - Colorado

Filling out the Medicaid Prior Authorization Form in Colorado can seem daunting, but with the right guidance, it can be a straightforward process. This guide offers clear, step-by-step instructions to help you navigate the online form efficiently.

Follow the steps to complete the form online.

1. Click ‘Get Form’ button to obtain the Medicaid Prior Authorization Form and open it in your preferred editing platform.
2. Begin by entering the request date in the designated field. This is the date you are submitting the authorization request.
3. In the patient information section, fill in the patient's Medicaid ID number, date of birth, and full name.
4. Proceed to the prescriber information section. Enter the prescriber's full name, street address, city, state, zip code, phone number, fax number, NPI number, and DEA number.
5. Next, specify the drug requested by entering its name, strength, frequency of dosing, and quantity.
6. Include the diagnosis information by stating the relevant diagnosis and, if applicable, the method of diagnosis.
7. In the failed medications section, list any medications that were tried and did not meet the patient's needs.
8. Document any contraindications or allergies the patient may have.
9. Record the current medications the patient is taking.
10. Include relevant lab values along with the date of lab results.
11. Provide a medical justification describing why prior authorization is needed for the requested medication.
12. Indicate where the medication will be administered by circling the appropriate option: client's home, long-term care facility, doctor's office, dialysis unit, or hospital.
13. Ensure all required information is included to avoid delays in the approval process. Review the prior authorization criteria as needed.
14. Finally, input the date and include the signature of the prescriber to confirm the accuracy of the information provided.
15. Once you have filled out all sections of the form, you can save changes, download, print, or share the completed form as needed.

Complete your Medicaid Prior Authorization Form online today.