Get Bmc Prior Auth Form

Filling out the Bmc Prior Auth Form is an essential step in obtaining prior authorization for anticoagulant medications. This guide provides a clear and user-friendly approach to help you complete the form online effectively.

Follow the steps to complete the Bmc Prior Auth Form online.

1. Press the ‘Get Form’ button to access the Bmc Prior Auth Form and open it in your preferred editor.
2. In the 'Patient Name' field, enter the name of the patient for whom the authorization is being requested.
3. Provide the 'Prescriber Name' along with the necessary contact information, including phone number and fax number.
4. Fill in the 'Member/Subscriber Number' and 'Group Number' to identify the patient's insurance plan.
5. Input the patient's 'Date of Birth' and 'Primary Phone' number for contact purposes.
6. Complete the address fields, ensuring to include the 'City, State ZIP' for both the patient and prescriber.
7. Indicate whether the authorization request is for initial or continuing therapy and, if applicable, provide the 'treatment start date'.
8. Select the patient's diagnosis from the options provided. If 'Other', specify the diagnosis in the designated field.
9. Choose the requested medication from the list available, noting the 'dose' that matches the patient's needs.
10. Confirm whether the patient has been stabilized on the requested medication by selecting 'Yes' or 'No'.
11. Indicate if the patient is unable to take for specific reasons, checking all that apply and providing necessary documentation.
12. Ensure to sign the form in the 'Prescriber Signature' section and date it appropriately.
13. Review all entries for accuracy before saving changes, with options to download, print, or share the completed form.

Complete your documents online efficiently to ensure a smooth authorization process.