Get Ohana Prior Auth Form

The Ohana Prior Auth Form is an essential document used for obtaining prior authorization for specific medical treatments. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the Ohana Prior Auth Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the member identification section by providing the Member ID# and Date Submitted.
3. Complete the fields for Name, DEA# (including X), Phone, NPI #, and Date of Birth (DOB) for the prescribing physician.
4. Provide the Prescriber Name and their contact details, including Phone and Fax.
5. Identify the drug being requested in the Drug Requested section, making sure to include strength and dosage form.
6. Indicate the Quantity and Sig (instructions) for the medication, along with the Start Date of this prior authorization request.
7. Document the Primary Diagnosis in the relevant section.
8. Record information regarding Psychosocial Counseling, including the date of the last session and compliance status.
9. Detail the plan for psychosocial counseling going forward, listing the method and the next three dates for planned sessions.
10. Indicate if this is a New Start or Reauthorization for an established patient; provide any necessary tapering schedule or urine drug screen as required.
11. Answer questions regarding the patient’s alcohol abuse and previous opioid use, including reasons for opioid use and any relapses.
12. Complete the Taper trial documentation if applicable, ensuring to note down attempts to taper including schedule, dose duration, and outcome.
13. Record the date KASPER was last queried for the patient.
14. Have the physician sign and date the form, certifying possession of a Drug Addiction Treatment Act waiver.
15. Once all fields are completed, save the changes, and download, print, or share the form as required.

Complete the Ohana Prior Auth Form online today to ensure timely processing of your request.