Get Or Ohp 3978 2021-2025

Filling out the OR OHP 3978 form for prior authorization requests for medications and oral nutritional supplements is a crucial task for healthcare providers. This guide will provide step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to complete the OR OHP 3978 form online.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Complete the 'Request Information' section. Enter the requesting provider's name, NPI, contact name, contact phone, contact fax, and type of prior authorization request. Also, provide the client ID, date of request, client name, and processing timeframe. Ensure to note the client date of birth.
3. Fill in the 'Service Information' section. Indicate the estimated length of treatment, start and end dates, primary diagnosis and diagnosis code, and frequency. If applicable, list any other pertinent diagnosis codes.
4. In the 'Drug/Product Information' section, provide the name, strength, quantity, and NDC of the product. Identify the participating pharmacy and include the pharmacy's phone number.
5. For oral nutritional supplements, complete the 'Line Item Information' section with procedure codes, modifiers, descriptions, units, and total dollars, ensuring no fields are left blank.
6. If applicable, answer the questions in the 'Patient Questionnaire' section, providing necessary details such as feeding method, history of malnutrition, and any other relevant medical conditions.
7. Finalize your submission by adding the requesting physician's signature and date. After all sections are properly filled out, you may save changes, download, print, or share the completed form.

Begin filling out your OR OHP 3978 form online today to ensure a smooth authorization process.