Get And Tuberculosis (tb) Products Prior Authorization ... - Kdheks

Completing the and Tuberculosis (TB) Products Prior Authorization Request Form online is essential for obtaining necessary medications covered by Medicaid. This guide provides clear, step-by-step instructions to ensure that users can fill out the form accurately and efficiently.

Follow the steps to efficiently complete the prior authorization request form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This action allows users to access the necessary document for completion.
2. Begin by filling in the beneficiary's name in the designated space. Ensure that the name matches the Medicaid records to avoid processing issues.
3. Enter the beneficiary's Medicaid ID number and date of birth in the specified fields. Providing accurate information is critical for successful authorization.
4. Complete the pharmacy information, including pharmacy name, Medicaid ID number, NPI number, phone number, and fax number. This information helps identify the provider and facilitates communication.
5. Fill in the drug name and the National Drug Code (NDC) requested. Make sure these details are correct to ensure the correct medication is authorized.
6. Provide the prescribing physician’s name, Medicaid ID number, NPI number, phone number, and fax number. This identifies the healthcare provider responsible for the prescription.
7. Indicate the diagnosis for which the and Tuberculosis medication is being prescribed. This section requires a brief explanation without diagnosis codes.
8. The prescribing physician must sign and date the form in the appropriate spaces. This signature verifies the authenticity of the request.
9. Once all sections are completed, the form should be submitted by faxing it to the Prior Authorization Unit at 1-800-913-2229. Ensure that the form is filled out in its entirety to avoid rejection.
10. After faxing, users may want to keep a copy of the completed form for their records. This is important for tracking the prior authorization process.

Complete your and Tuberculosis (TB) Products Prior Authorization Request Form online today to ensure timely medication access.