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Click ‘Get Form’ to open the silverscript prior authorization form in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, Member ID, Medicare ID, date of birth, and contact details.
Next, complete the 'Prescriber and Pharmacy Information' section. Include the prescriber's name, specialty, DEA number, and pharmacy details.
In the 'Information for Requested Drug' section, specify the drug name, whether it is brand or generic, strength, dosage form, quantity per 30 days, and directions for use.
Provide a diagnosis and ICD-10 code to support your request. If an expedited review is necessary due to health concerns, indicate this at the top of the form.
Complete the 'Medical Justification' section by detailing why formulary alternatives are ineffective or cause adverse effects. Attach additional pages if needed.
Finally, ensure all fields are filled accurately before submitting. Once completed, fax the form to 1-855-633-7673 as instructed.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (37 Votes)
2012	4.4 Satisfied (573 Votes)

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What is the phone number for SilverScript prior authorization?

You may also ask us for a coverage determination by phone at 1-866-235-5660 or through our website at .silverscript.com. Who May Make a Request: Your prescriber may ask us for a coverage determination on your behalf.

Is CVS Caremark the same as SilverScript?

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.

How to get a prior authorization form?

Heres how it typically works: Consult Your Doctor. Start by discussing your treatment plan and any specific medications your provider recommends. Contact Your Insurance Provider. Call your insurance company or log into their online portal to check if prior authorization is required. Submit the Request. Await Approval.

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.

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.

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