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PRIOR AUTHORIZATION REQUEST FORM, (alpha), (Darbepoietin alpha) Complete form in its entirety and fax to: Empire Pharmacy Management at FAX (845) 6953191 OR (845) 6953804 Or Mail to: Prior Approval.
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Empire plan predetermination form FAQ
The prior authorization process can help you: Reduce the cost of expensive treatments and prescriptions by first requiring you to try a lower-cost alternative. Avoid potentially dangerous medication combinations. Avoid prescribed treatments and medications you may not need or those that could be addictive.
Prior authorization — the act of authorizing specific services or activities before they are rendered or occur.
Use the Prior Authorization tool within Availity or. Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181.
Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
Empire payer name and ID: Your Payer Name is Empire BlueCross BlueShield HealthPlus. Your Payer ID is 27514. Note: If you use a billing company or clearinghouse for your EDI transmissions, please work with them on which payer ID they want you to use.
Fax this form to 844-493-9206. For PA requests by phone or if you have questions, call Provider Services at 800-450-8753. Please allow Empire BlueCross BlueShield HealthPlus at least 24 hours to review this request.
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification.
The prior authorization process begins when a service prescribed by a patient's physician is not covered by their health insurance plan. Communication between the physician's office and the insurance company is necessary to handle the prior authorization.
Medicare authorization form pdf Related content
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