Dispute Category Medication precertification Request Form 2025

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Prior authorization requires your doctor or provider to obtain approval from your health plan before providing health care services or prescribing prescription drugs. Without prior authorization, your health plan may not pay for your treatment or medication.
It typically takes 24 to 72 hours. You may check the status of your prior authorization request on the prior authorizations page. You may also contact your doctors office directly.
Instructions: This form is to be used by participating physicians and providers to obtain coverage for a formulary drug requiring prior authorization (PA), a non-formulary drug for which there is no suitable alternative available, or any overrides of pharmacy management procedures such as step therapy, quantity limit
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.
To get prior authorization, your doctor must first submit a request for a specific procedure, test or prescription. They will look at your overall health or any chronic conditions to make that decision. Then theyll share the request with Aetna.
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