Get Prior Authorization Request Www.unicare.com

Completing the Prior Authorization Request form through UniCare is a vital step to ensure proper treatment and medication approval. This guide offers clear instructions to help you navigate the form efficiently and effectively.

Follow the steps to successfully complete the authorization request.

1. Press the 'Get Form' button to access the Prior Authorization Request form and open it for editing.
2. Fill in the ‘requested medication and dose’ section, including today’s date and diagnosis. Ensure this information is accurate, as it is critical for the approval process.
3. Provide patient information by entering the last name, first name, middle name, member ID number, street address, city, state, ZIP code, date of birth, and sex.
4. Input prescriber information, including the prescriber's last name, NPI number, DEA number, street address, city, state, ZIP code, phone number, and fax number.
5. Complete the pharmacy information section by including the pharmacy's name and phone number to facilitate communication.
6. Detail the medical information. Attach or list the patient's complete treatment history, including any current treatments and previously failed pain treatments.
7. Answer all relevant questions concerning the patient’s health status, such as pregnancy, allergies to opioid medications, renal or hepatic function, and current daily functioning.
8. Indicate if the patient has been screened for the risk of substance-use disorder, including the screening tool and results where applicable.
9. Confirm whether the patient has an up-to-date Patient and Provider Agreement, including all necessary components like treatment goals and risk reviews.
10. Finalize by signing the form where indicated. If using a signature stamp, the prescriber must initial it, as signatures by agents are not acceptable.
11. After completing the form, review all entries for accuracy. You can then save the document, download, print, or share it as needed.

Start completing your Prior Authorization Request online today for prompt medication approval.