Get Topeka, Ks 666013571 - Kdheks

Filling out the Topeka, KS 666013571 - Kdheks form is an important part of the process for requesting prior authorization for medication. This guide will provide you with a clear, step-by-step approach to help you complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to access the form and open it in an editor.
2. Begin by entering the beneficiary's name in the designated field. Ensure that the name matches the records available with Medicaid.
3. Fill in the beneficiary's Medicaid ID number in the appropriate section, followed by the date of birth in the format of month/day/year.
4. Next, provide the name of the pharmacy where the prescription will be processed, followed by the pharmacy's Medicaid ID and NPI numbers.
5. Include the pharmacy’s contact phone number as well as the fax number for documentation purposes.
6. Enter the National Drug Code (NDC) for the medication being requested in the specified field.
7. Next, list the name of the prescribing physician along with their Medicaid ID and NPI numbers.
8. Also, provide the physician's phone number and fax number for their records.
9. Document the prescribed taper schedule clearly in the provided space to ensure that all necessary details are captured.
10. Indicate if there is documentation of a new muscle injury by checking 'Yes' or 'No' as applicable.
11. Fill out any details regarding the preferred drug that has been tried, and provide a justification for the medical necessity of any non-preferred drug.
12. Finally, the prescribing physician or their designee must sign the form and include the date of signature.
13. Once completed, the form should be faxed to the Prior Authorization Unit at the specified number. Ensure that all fields are filled out completely to avoid delays in processing.

Complete the documentation process online today to ensure timely prior authorization!