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The document is a Prior Authorization Form for the medications Potiga and Vimpatt, intended for use by healthcare providers to request approval from UPMC Health Plan Pharmacy Services. It requires detailed patient and provider information, medical history, and justification for the requested medication, including past treatment failures and side effects. The form emphasizes the need for completeness to avoid delays in processing.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Does the UPMC health plan require referrals?

UPMC for You covers services that are medically necessary. Some of the services may have limits, copayments, or need a referral from your PCP or require prior authorization by UPMC for You.

Why is it so hard to get a prior authorization?

A prior authorization form will include information about you, your medical conditions, and your health care needs. Its important to fill out the form completely and accurately. Incomplete or incorrect information could delay your request or result in a denial.

What happens if you dont get prior authorization?

If you dont get permission from your health plan, your health insurance wont pay for the service. Youll be stuck paying the bill yourself.

Is prior authorization always required?

Is prior authorization required in emergency situations? No, prior authorization is not required if you have an emergency and need medication. However, coverage for emergency medical costs are subject to the terms of your health plan.

Does UPMC require prior authorization?

UPMC Health Plan requires a prior authorization request for speciﬁc procedures or treatments to determine whether coverage of a request will be approved or denied.

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What are the requirements for prior auth in UPMC?

The UPMC Health Plan Prior Authorization Form must include patient demographics, provider information, details of the requested service or procedure, ICD-10 codes, clinical information supporting the request, and any relevant treatment history.

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Does the UPMC health plan require referrals?

Why is it so hard to get a prior authorization?

What happens if you dont get prior authorization?

Is prior authorization always required?

Does UPMC require prior authorization?

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What are the requirements for prior auth in UPMC?

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