Get Paramount Prior Authorization

Filling out the PARAMOUNT PRIOR AUTHORIZATION form can seem daunting, but with clear guidance, you can complete it efficiently. This guide provides step-by-step instructions to help you navigate each section of the form online.

Follow the steps to complete the PARAMOUNT PRIOR AUTHORIZATION form.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin by entering the member information. Fill in the member name, date of request, Paramount member ID number, date of birth, and diagnosis (ICD-9) in the provided fields.
3. Next, provide your information as the provider. Include your name, signature, address, provider ID, phone number, fax number, and contact name.
4. Indicate the plan in which the Paramount member is enrolled by checking the appropriate box for commercial plans, Paramount Marketplace, or Paramount Advantage.
5. In the drug request section, detail the drug, dosage, route, and frequency requested. Additionally, include required patient information such as height, weight, and lab values.
6. If the requested drug is self-administered, specify which Paramount Specialty Network Pharmacy will be supplying the drug.
7. Complete the medical and clinical history section by detailing the therapeutic indication/diagnosis, duration of treatment, current signs and symptoms, and previous treatments/therapies along with results.
8. Review all entered information for accuracy. Ensure all medical histories, lab values, and supporting documentation are attached as required.
9. Upon completion, save your changes, download, print, or share the filled form as necessary.

Start completing your forms online for efficient processing.