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A North Carolina Medicaid prior authorization form is a document used by North Carolina-based medical professionals to request Medicaid coverage for a non-preferred drug. On the form, the person making the request must provide the medical justification for not prescribing a drug from the Preferred Drug List.
The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patients insurance provider. As mentioned in the How does prior authorization work? section above, this will then often prompt a time-consuming back and forth between the provider and payer.
If you have questions related to Blue Shield Promise medical or pharmacy authorizations, contact Provider Services at (800) 468-9935.
Providers also have the option to complete and fax the California standard Prescription Drug Prior Authorization Request Form to (888) 697-8122.
Calls and faxes are accepted 24/7. You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-32111-888-693-3211.
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Fax the completed form to the Prior Authorization Department at 1-800-743-1655. Check appropriate box. Designate type of request.
Blue Shield of CA Provider. Prior authorization is the requirement that a physician or other qualified provider obtain approval from Blue Shield before prescribing a specific medication, procedure and/or service. Blue Shield providers can submit medical and pharmacy authorizations online in AuthAccel.
Fax: (916) 350-8860, Monday - Friday, 6:00 a.m. - 6:30 p.m.

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