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How to use or fill out MEDCO-31 - Request for Prior Authorization of Medication Form with DocHub
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Click ‘Get Form’ to open the MEDCO-31 form in our platform's editor.
Begin by entering the 'Request date' and 'BWC claim number' in the Injured Worker Information section. Ensure accuracy as this information is crucial for processing.
Fill in the 'Injured worker name' and 'Injured worker date of injury'. This identifies the individual for whom the medication request is being made.
In the Prescriber Information section, input your details including 'Prescriber', 'Prescriber NPI', 'Prescriber phone', and 'Prescriber fax number'. This establishes your identity as the prescribing authority.
Next, detail the medication requested along with conditions being treated. Include the 'Medication name', relevant 'ICD-9 code(s)', and their descriptions. If applicable, indicate if it’s a non-sterile or sterile compound.
For post-surgical requests, enter the 'Date of scheduled surgery' and provide a justification for your request. Attach additional documentation if necessary.
Finally, ensure you sign and date the form in the designated areas to validate your request before submitting it via fax to 866-213-6066.
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Heres how it typically works: Consult Your Doctor. Start by discussing your treatment plan and any specific medications your provider recommends. Contact Your Insurance Provider. Call your insurance company or log into their online portal to check if prior authorization is required. Submit the Request. Await Approval.
Can I initiate my own prior authorization?
You can submit a request on your own. Find the appropriate prescription drug or medical procedure authorization form for your situation.
What is a Medco 31?
Before surgery: If a physician needs to request pain medication or other post-surgical drugs before surgery, they can submit the MEDCO-31 form for approval. The surgery date must be included on the form. This request is limited to a 30-day supply.
What documents are required for prior authorization?
Step-by-Step Breakdown of Required Documents Patient Information. Insurance Plan Eligibility and Coverage Details. Diagnosis Codes (ICD) Procedure Codes (CPT/HCPCS) Medical Records Supporting Necessity. Physician and Facility Details. Authorization Request Form. Supporting Attachments and Authorization Notes.
medco prior authorization forms
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Express Scripts Medicare (PDP) 2026 Formulary (List of
Prior Authorization: You or your prescriber is required to get prior authorization for certain drugs. This means that you will need to get approval fromRead more
Master Key Request Form. Name of End User. Electronic Key Schedule. Serialization Instructions. Stamping Instructions. Letters of Authorization. Existing MasterRead more
Justification Provide a detailed explanation of how the requested medication(s) is related to the treatment of the work-related injury and allowed conditions.Read more
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