Get Specialty Pharmacy Prior Authorization Form - Caresource

Completing the Specialty Pharmacy Prior Authorization Form - CareSource online is a straightforward process that requires attention to detail. This guide provides clear, step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Specialty Pharmacy Prior Authorization Form - CareSource in an online editor.
2. Enter the patient's information in the designated fields, including their name, date of birth, sex, address, and phone number.
3. Provide details about the patient's primary and secondary insurance, including the insurance names, group numbers, and ID numbers.
4. Fill in the medication information section, specifying the drug name and strength, dosage form, dosage interval, route of administration, and the dates of service.
5. In the statement of medical necessity section, explain the rationale for the medication request. Attach any relevant clinical notes to support medical necessity.
6. Address the medication history for diagnosis by responding to the questions regarding previous treatments and outcomes.
7. Indicate the drug claim submission details, selecting whether it will be submitted by the prescribing physician, CVS Caremark, or another entity, and provide the contact name, phone number, fax number, and tax ID number.
8. Specify the place of service by selecting from the available options, such as the physician’s office, member’s home, or other.
9. Fill out the prescribing physician section with the physician's name, contact information, NPI number, and other required details.
10. Complete the drug claim submission type by selecting between medical benefit or pharmacy benefit and providing details for the dispensing pharmacy.
11. Ensure all information is complete and accurate before finalizing. Once finished, users can save changes, download, print, or share the completed form.

Start filling out the Specialty Pharmacy Prior Authorization Form - CareSource online today to ensure swift processing of requests.