Get Nc Dma: April 2002 Special Medicaid Bulletin - Prior Authorization ... - Ncdhhs

This guide provides comprehensive instructions for completing the NC DMA: April 2002 Special Medicaid Bulletin – Prior Authorization form. Following these steps will help users efficiently navigate the process and ensure all necessary information is submitted accurately.

Follow the steps to complete the prior authorization form efficiently.

1. Press the ‘Get Form’ button to obtain the NC DMA: April 2002 Special Medicaid Bulletin form and open it in your document handling system.
2. Fill out the recipient's details, including their full name, Medicaid ID, date of birth, and other relevant identifiers. Make sure to check if the recipient is Medicare-eligible or institutionalized, and indicate their pregnancy status if applicable.
3. Provide the prescriber information, including the prescriber's full name, DEA number, address, and contact details. This information must be mandatory for processing the authorization.
4. Indicate the drug name and required quantity. Additionally, specify the length of therapy, dosage, and frequency of dosing to ensure clarity and accuracy.
5. Detail the diagnosis, previous therapy, and the reason for using the specified non-formulary drug. Include relevant lab data and any information regarding potential drug interactions.
6. Review all information for accuracy and completeness before submitting. If all required fields are filled, you can either fax or mail the form, or save it to email as an attachment to ACS State Healthcare.
7. After submission, if necessary, follow up with ACS to confirm receipt and processing status of your prior authorization request. Emergency dispensing of a 72-hour supply can be executed if needed, with a paper claim for reimbursement.
8. Save your changes, download your completed form, or print it for your records. Ensure to keep a copy of any correspondence you have for reference.

Ready to file your forms online? Start now and ensure timely approval of your prior authorization requests.