Get Wa Hca 13-835a 2016-2025

The WA HCA 13-835A form is a Pharmacy Information Authorization document that allows healthcare providers to request prescription authorizations for clients. This guide will assist you in navigating the process of completing this form online, ensuring that all necessary information is accurately provided.

Follow the steps to complete the WA HCA 13-835A form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the organization type by selecting the appropriate number indicating whether this is for pharmacy authorization or reimbursement rate adjustment.
3. Indicate the authorization type as either a new request or an update for an existing authorization.
4. Provide the client's full name, including last name, first name, and middle initial.
5. Input the Client ID, which consists of nine numbers followed by 'WA'.
6. If applicable, enter the previous authorization number for updates.
7. Enter the Pharmacy NPI number, which is a unique 10-digit number assigned to the pharmacy.
8. Provide the pharmacy fax number without any dashes or spaces.
9. Input the prescriber NPI number, also a unique 10-digit identifier.
10. Specify the prescriber specialty for clarity on the area of expertise.
11. Enter the prescriber's phone number and fax number, excluding any formatting.
12. List the date of fill for the prescription if it has already been dispensed, otherwise, use the authorization request date.
13. Indicate whether the prescription was signed 'Dispense as Written' or if substitution was permitted.
14. For the required drug name, provide the name, strength, and form of the medication.
15. If applicable for rate adjustments, enter the actual per unit cost and the AWP per unit cost.
16. Record the RX number assigned to the prescription, along with the wholesaler of the medication.
17. Input the product ID in an 11-digit format, ensuring it is in the correct structure.
18. Specify the quantity of the product requested.
19. Enter how many days the prescribed quantity is expected to last.
20. Provide the directions for use as prescribed.
21. If the prescription is signed 'Dispense as Written', input the corresponding product selection code.
22. Enter the diagnosis code if known, describing the relevant medical condition.
23. Provide a short description of the diagnosis name.
24. Indicate the patient's residence status with the corresponding code.
25. Add any necessary comments to further explain medical necessity.
26. Once all sections are complete, review your entries, then save changes, download, print, or share the form as needed.

Complete your WA HCA 13-835A form online today to ensure timely processing of prescription authorizations.