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Drugs That May Require Prior Authorization Drug ClassDrugs in ClassAfinitorAfinitor, Afinitor Disperz, everolimusAmpyraAmpyraAmvuttraAmvuttraAndrogens-Anabolic SteroidsAndrol-50, Danazol, Nandrolone, Oxandrin242 more rows
to the insurer: Patient name, date of birth, insurance policy number, and other relevant information. Physician and facility information (eg, name, provider ID number, and tax ID number) Relevant procedure and HCPCS codes for products/services to be provided/performed.
Prior authorization is an approval of coverage from your insurance company, not your doctor. Its a restriction put in place to determine whether or not they will pay for certain medicines. It doesnt affect cash payment for prescriptions. Plus its only required on those prescriptions when billed through insurance.
Prior authorization is required before certain services are rendered to confirm medical necessity as defined by the members plan. Use the Meridian tool to see if a pre-authorization is needed. If an authorization is needed, you can access our login to submit online.
To request PA information or receive additional support, please contact us at 866-606-3700 (TTY: 711). Below is a list of services that require prior authorization from Meridian before your healthcare provider can proceed with treatment. PRIOR AUTHORIZATION REQUIRED FOR SOME OR ALL OF THE SERVICES?

People also ask

Prior authorizationsometimes called preauthorization or precertificationis a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
For a pharmacist to dispense a controlled substance, the prescription must include specific information to be considered valid: Date of issue. Patients name and address. Patients date of birth.
Basic Information Required for the Prior Authorization Request The name and Medical Assistance ID number (i.e., ACCESS card number) of the beneficiary. The name and phone number of the contact person at the prescribers office. The prescribers specialty or field of practice.

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