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How to use or fill out silverscript pa form with our platform
- Click ‘Get Form’ to open the silverscript pa form in the editor.
- Begin by filling out the 'Patient Information' section. Enter the patient's name, member ID, Medicare ID, date of birth, sex, and address.
- Next, complete the 'Prescriber and Pharmacy Information' section. Provide the prescriber's name, specialty, DEA number, NPI number, and contact 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 if it is a new prescription or refill.
- Provide medical justification for the non-formulary drug request in the 'Medical Justification' section. Include details about previous formulary drugs attempted and any adverse effects experienced.
- Once all fields are completed accurately, review your entries for correctness before submitting.
- Finally, fax the completed form to 1-855-633-7673 as instructed. Ensure you do not include any cover pages.
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Got questions?
How can I create an electronic signature in my silverscript prior authorization form on Android?
Approving paperwork on a mobile device is fast, simple, and doesn’t require software installation when you have an account with DocHub. Log in from any browser, complete your empty fields with your information, and click on Sign → Create your signature. You can draw your eSignature just as you usually do on paper, add its image to your silverscript prior authorization form, or type in your name and stylize its look. No matter what option you choose, your document will be valid.
Do I need to install software to modify my silverscript pa form?
When you edit your silverscript pa form with DocHub, you merely need a steady web connection and virtually any web browser installed on your device. No need to install any third-party software or research tutorials. Simply open a tab with DocHub, drag and drop your file, and edit it on the spot.
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