Get Faqs Proact, Inc.

This guide will assist you in accurately completing the FAQs ProAct, Inc. document for the prior authorization request. Follow the steps below to ensure all necessary information is provided for a smooth approval process.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the member information section. Required fields include member name, insurance ID number, date of birth, and contact information. Ensure accuracy in all input.
3. Next, provide the provider information. This includes the provider’s name, NPI number, office phone, and address. Accuracy is crucial as this information will be used for communication regarding the request.
4. In the medication information section, enter the medication name and strength. Mark if requesting the brand medication or if this is a continuation of therapy. Include clear directions for use and specify the dosage form.
5. Proceed to the clinical information section. Select the appropriate diagnosis from the options provided. If 'other diagnosis' is selected, specify the diagnosis clearly. Additionally, include the relevant ICD-10 codes.
6. Indicate the medications the patient has a failure, contraindication, or intolerance to by checking the relevant boxes. This information supports the request for approval of the prescribed medication.
7. For quantity limit requests, fill in the quantity requested per day and provide the reason for exceeding plan limitations by selecting applicable options.
8. In the comments section, include any additional pertinent information that may assist in the review process. This can involve other diagnoses, symptoms, or medications tried.
9. Once all sections are completed, review the document for accuracy. Ensure that any required fields are filled out correctly to avoid denial of the request.
10. Finally, fax the completed form to the provided number to initiate the prior authorization review. Retain a copy for your records.

Start filling out the FAQs ProAct, Inc. form online today for efficient processing of your request.