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Click ‘Get Form’ to open the Illinois Prior Authorization Request Form in our platform's editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, date of birth, and nine-digit HFS Recipient number.
Next, complete the 'Prescriber Information' section. Input the prescriber's name, phone number, fax number, and NPI number.
If applicable, provide 'Pharmacy Information' by entering the pharmacy name and contact details.
In the 'Medication' section, specify the medication name, strength, NDC number (if available), effective begin date, refills needed, and quantity.
Indicate whether this is a new prescription or a renewal and include directions for use along with diagnosis or ICD code.
List all medications previously tried for this indication and describe any failures experienced.
Provide additional information justifying the need for this medication over alternatives that do not require prior authorization.
If requesting an override of limitations, check the appropriate boxes provided in the form.
Finally, ensure that the prescriber or designee signs and dates the form before submission.

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How to obtain prior authorization?

How To Get Prior Authorization: Step-by-Step Guide Step 1: Check client eligibility. Step 2: Determine if a code or service requires Prior Authorization. Step 3: Find and complete forms. Step 4: Submit a PA request. Step 5: Check the status of an authorization.

Can I request 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.

Are prior authorizations legal in Illinois?

A prior authorization approval shall be valid for the lesser of 6 months after the date the health care professional or health care provider receives the prior authorization approval or the length of treatment as determined by the patients health care professional or the renewal of the plan, and the approval period

How to get a prior authorization form?

To receive coverage for a medication requiring prior authorization, you can: Ask your healthcare provider to submit the request. Your healthcare provider can submit the request online, by fax or phone by accessing our providers prior authorization information. Submit your own prior authorization request.

Who is responsible for obtaining preauthorization?

Studies show the average cost for prior authorization approval on primary care practices ranged from $2,161 to $3,430 annually per full-time physician. In addition to the impact on physicians, prior authorization requirements have been found to harm patient care.

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