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Universal Pharmacy Programs Request Form Pharmacy Utilization Management Department 705 Mt. Auburn St. Watertown MA 02472 Commercial Provider Services 888 884-2404 Fax 617 673-0988 Tufts Medicare Preferred HMO and PDP Tufts Health Plan Senior Care Options HMO SNP Provider Relations 800 279-9022 Fax to 617 673-0956 This form is only used for pharmacy requests that require prior authorization review by Tufts Health Plan. For details of Tufts Health Plan Pharmacy Programs go to tuftshealthplan.com/providers. For Tufts Medicare Preferred HMO PDP and Tufts Health Plan Senior Care Options HMO SNP members click here for criteria/request form for Medicare Part B vs Part D Coverage Determinations. PATIENT INFORMATION PRESCRIBER INFORMATION Name Date Specialty Member ID DOB Tufts Health Plan Provider ID Diagnosis Phone Relevant Co-morbid Diagnoses Office Contact Additional Comments/History NPI Prescriber Signature required REQUESTED DRUG Name and Strength Select one Dispense As Written Generic S....

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How to fill out the Tufts Prior Authorization Form online

Filling out the Tufts Prior Authorization Form online is an essential step for submitting pharmacy requests that require review by Tufts Health Plan. This guide provides clear instructions to help you complete the form accurately and efficiently.

Follow the steps to complete your form with ease.

  1. Press the ‘Get Form’ button to access the Tufts Prior Authorization Form and open it in the editor.
  2. Begin by filling in the patient information section. Enter the patient's name, date of birth, and member ID. Ensure all details are accurate to avoid processing delays.
  3. Next, input the prescriber information. Include the prescriber's name, specialty, phone number, and Tufts Health Plan provider ID. It is critical that this information is correct, as it identifies the person responsible for the request.
  4. In the requested drug section, specify the drug name and strength. Select either 'Dispense As Written' or 'Generic Substitution Authorized' based on your preference.
  5. For Tufts Medicare Preferred HMO, PDP, and Senior Care Options members, indicate if the member's condition requires expedited review by checking 'Yes' or 'No.' If 'Yes,' certify that the standard review time may jeopardize the member's health.
  6. Complete the clinical justification for the request. Provide detailed information regarding any adverse reactions or treatment failures, along with the rationale for needing the requested drug.
  7. If applicable, answer the question regarding whether the request is for a tier exception. Check 'Yes' or 'No' and provide any necessary documentation to support your request.
  8. After filling in all sections, review the form to ensure accuracy and completeness. A signature from the prescriber is required to finalize the submission.
  9. Once satisfied, save your changes to the form. You may download, print, or share the completed form as needed.

Complete your Tufts Prior Authorization Form online today to ensure timely processing.

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While submitting a prior authorization request yourself is generally not standard practice, you can support your healthcare provider in gathering necessary information. Discussing your needs and ensuring they have the Tufts Prior Authorization Form can expedite the process. Communication is key, so don’t hesitate to remain proactive.

Patients typically cannot submit a prior authorization request for themselves; this is usually handled by healthcare providers. However, you can encourage your provider to submit the necessary request on your behalf. It's useful to keep a copy of your Tufts Prior Authorization Form for your records and to discuss it with your provider.

The fax number for submitting Tufts Health Direct prior authorization forms is available on their official website or through customer service. When you have the correct fax number, it will help ensure timely processing of your requests. Include your completed Tufts Prior Authorization Form to avoid delays.

Tufts offers both Medicaid and Medicare plans, catering to a diverse range of healthcare needs. Each plan has its specific benefits and eligibility criteria. Understanding which plan suits your situation is important for optimal healthcare access. If you are unsure, reviewing the details on the Tufts website or using the Tufts Prior Authorization Form can clarify your options.

Generally, the responsibility for obtaining preauthorization falls on your healthcare provider. However, as a patient, it’s beneficial to follow up on the process to ensure everything is on track. Using the Tufts Prior Authorization Form can facilitate communication between you and your provider regarding the necessary approvals.

No, the Tufts EPO plan generally does not require referrals for specialist care. This flexibility allows you to seek necessary treatments without added administrative steps. However, it's wise to confirm coverage with your healthcare provider. Always keep handy the Tufts Prior Authorization Form in case it's required.

Yes, the Tufts POS plan does typically require referrals for specialist services. You should consult with your primary care provider to obtain the necessary referrals. This process is important to ensure that your care is well-coordinated. The Tufts Prior Authorization Form may be needed for certain procedures, so keep that in mind.

To obtain prior authorization from insurance, begin by contacting your insurance company directly for their specific requirements. Completing the Tufts Prior Authorization Form accurately will help streamline the process. Always provide any requested medical records or supporting documentation to enhance your chances of approval.

To reach the Tufts Medicare prior authorization department, you can call their dedicated helpline, which is available for assistance. It's best to have your Tufts Prior Authorization Form ready for reference during the call. By having all necessary information at hand, you can get faster responses to your queries.

When entering a prior authorization, it is essential to include accurate patient details, the specific service or treatment requested, and the relevant medical justification. You must also fill out the Tufts Prior Authorization Form completely to ensure a smooth process. Comprehensive documentation can prevent delays and help expedite approval.

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