Get Prior Authorization Form - Magellan Health Services Tenncare...

Filling out the Prior Authorization Form is a crucial step in ensuring that patients receive the necessary medications covered by TennCare. This guide provides a clear, step-by-step approach to completing the form online effectively and accurately.

Follow the steps to complete the form online seamlessly.

1. Press the ‘Get Form’ button to access the Prior Authorization Form and open it in your preferred document editor.
2. Fill out the member information section by entering the last name, first name, ID number, and date of birth of the individual who is receiving the treatment.
3. In the prescriber information section, enter the last name and first name of the prescriber, along with their NPI number, DEA number, phone number, and fax number.
4. Indicate whether the prescriber is a TennCare provider with a Medicaid ID and if they are a single-patient contract holder for this patient by selecting 'Yes' or 'No'.
5. Complete the requested general/non-preferred drug information by providing the medication name, strength, directions for use, and whether the patient may use a generic equivalent if available.
6. Specify the duration of therapy requested. Keep in mind that documentation that is not requested on the form should not be included.
7. In the clinical criteria documentation section, answer questions related to the diagnosis, previous drug trials, and any adverse events experienced by the patient. Note any relevant information about the current medication regimen.
8. Ensure that the prescriber signs the form, confirming that the information provided is accurate. This signature is required for the form to be processed.
9. After completing all sections, save changes to your document. You have the option to download, print, or share the completed form as needed.

Complete your Prior Authorization Form online to ensure timely processing and access to medications.