Get Scan Health Plan Express Scripts Prior Authorization 2021-2025

Filling out the SCAN Health Plan Express Scripts Prior Authorization form is an essential process for obtaining medication coverage. This guide provides step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to complete the Prior Authorization form online.

1. Press the ‘Get Form’ button to access the Prior Authorization form and open it in your preferred document editor.
2. Begin by entering the member's last name in the designated field.
3. Next, provide the member's first name accordingly.
4. Input the SCAN ID number in the given space.
5. Include the member's date of birth in the required format.
6. Enter the prescriber's name as it appears on the prescription.
7. Fill in the contact person's name if different from the prescriber.
8. Provide the office phone number for follow-up communications.
9. Include the office fax number where necessary.
10. Specify the medication that is being requested.
11. Document the diagnosis related to the medication request.
12. In Section A, answer the question regarding the diagnosis of relapsing forms of Multiple Sclerosis by selecting 'Yes' or 'No', and provide additional information if 'No' is selected.
13. Answer the second question in Section A regarding whether the prescription is written by a neurologist by selecting 'Yes' or 'No', and provide additional details as needed.
14. In Section B, ensure that the physician signs the form and adds the date.
15. Once all fields are completed, save your changes, and choose to download, print, or share the completed form.

Complete your SCAN Health Plan Express Scripts Prior Authorization form online today.