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Priority Partners Prior Authorization Form 2025

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The document is a Pharmacy Prior Authorization Form intended for internal use, designed to collect necessary information for medication requests. It includes sections for member and provider details, medication specifics, clinical rationale, previous trials, and certification of accuracy by the provider. The form must be completed and faxed along with supporting progress notes to the pharmacy department.

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Click ‘Get Form’ to open the Priority Partners Prior Authorization Form in our platform.
Begin by filling out the 'Member Info' section. Enter the member's name, Medicaid number, date of birth, sex, and PPMCO number clearly.
Next, move to the 'Provider Info' section. Input the provider's name, office telephone number, contact name, and office fax number.
In the 'Medication Requested' area, specify the drug name, strength, dosage/frequency (SIG), and provide a diagnosis or clinical rationale. Remember to attach any pertinent labs.
Document any previous formulary trials by listing the drug name/strength/dosage along with dates and treatment outcomes.
Finally, ensure that the provider signs and dates the form certifying that all information is complete and accurate before submission.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (176 Votes)

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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.

Why is it so hard to get a prior authorization?

Drugs That May Require Prior Authorization Drug ClassDrugs in Class Benlysta Benlysta Bimzelx Bimzelx Botox Botox Branded Riluzole Products Exservan, Tiglutik Kit242 more rows

Is Priority Partners the same as Johns Hopkins?

Priority Partners is owned by Johns Hopkins Health Plans and the Maryland Community Health System.

What hospitals are associated with Johns Hopkins?

Hospitals The Johns Hopkins Hospital. 1800 Orleans St, Baltimore, MD 21287. Johns Hopkins Childrens Center. Johns Hopkins Bayview Medical Center. Sibley Memorial Hospital. Suburban Hospital. Johns Hopkins Howard County Medical Center. The Levi Watkins, Jr., M.D., Outpatient Center. Johns Hopkins All Childrens Hospital.

How to obtain prior authorization?

The Prior Authorization Process Flow The healthcare provider must check a health plans policy or prescription to see if Prior Authorization is needed for the prescribed treatment. The healthcare professional must sign a Prior Authorization request form to verify the medical necessity claim.

What insurance plans does Johns Hopkins accept?

We provide innovative managed care programs in Medicaid, Medicare, TRICARE Prime and employee group health plans, guided by the academic and clinical excellence of Johns Hopkins Medicine.

priority partners prior authorization phone number

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What does Priority Partners cover in Maryland?

To confirm coverage of your specific physician or provider, please contact the insurer directly. Aetna. CareFirst BlueCross BlueShield. Cigna Healthcare* First Health. Geisinger Health Plan. Humana. Johns Hopkins Health Plans. Kaiser Permanente of the Mid-Atlantic States.