Some prescriptions and over-the-counter medicines require prior authorization for Medicaid reimbursement. Depending upon the drug, either the prescribing physician or the dispensing pharmacist may submit the request.

You must file claims within 180 days from the date services were performed, unless there's a contractual exception.

The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider. As mentioned in the “How does prior authorization work?” section above, this will then often prompt a time-consuming back and forth between the provider and payer.

Both claims should be submitted to payer ID 68024.

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

16 Tips That Speed Up The Prior Authorization Process Create a master list of procedures that require authorizations. Document denial reasons. Sign up for payor newsletters. Stay informed of changing industry standards. Designate prior authorization responsibilities to the same staff member(s).

Please call us at 800.753. 2851 to submit a verbal prior authorization request if you are unable to use Electronic Prior Authorization. Prior Authorization criteria is available upon request.

Call Express Scripts at 877-603-1032, and let them do all the work. For most medications, Express Scripts will be able to contact your doctor and arrange for your first mail-order supply. Ask your doctor for a new prescription for up to a 90-day supply, plus refills for up to one year (if appropriate).