Get Medicare Prior Authorization Form - Priority Health

Filling out the Medicare Prior Authorization Form - Priority Health can seem daunting, but by following clear steps, you can complete the process efficiently. This guide provides detailed instructions tailored to help users successfully navigate each section of the form online.

Follow the steps to fill out the Medicare Prior Authorization Form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the member information section by entering the last name, first name, date of birth (DOB), gender, and ID number. Make sure all entries are legible.
3. Fill in the primary care physician's name and provide their contact details, including address, NPI number (National Provider Identifier), phone number, fax number, and contact name.
4. In the drug information section, specify the drug product being requested (e.g., 0.125 mg tablet), start date for the medication, last dose date if applicable, and dosing frequency.
5. Review the prior authorization criteria to ensure the conditions for coverage are met. Indicate what condition the drug is being requested for, such as atrial fibrillation or heart failure.
6. Address each question regarding the efficacy and safety of the prescribed dosage, particularly for patients aged 65 and older. Ensure that all answers are provided in a clear and concise manner.
7. If applicable, indicate whether an exception request is being made for waiver of prior authorization requirements and provide a detailed explanation for the request.
8. Once every section is filled out, review the entire form for completeness and legibility. You can then save changes, download, print, or share the form as needed.

Complete your Medicare Prior Authorization Form online today for effective management of your healthcare needs.