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06/04/2013 Prior Authorization AETNA BETTER HEALTH OF PENNSYLVANIA Non -Formulary Medications (PA88) This fax machine is located in a secure location as required by HIPAA regulations

06/04/2013 Prior Authorization AETNA BETTER HEALTH OF PENNSYLVANIA Non -Formulary Medications (PA88) This fax machine is located in a secure location as required by HIPAA regulations-2026

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4.5 out of 5

53 votes

The document outlines the process for obtaining prior authorization for non-formulary medications through Aetna Better Health of Pennsylvania. It includes instructions for completing a form that requires patient and physician information, as well as specific questions to determine eligibility for coverage based on previous medication trials, contraindications, and medical necessity. The document emphasizes the need for supporting documentation and provides contact information for inquiries.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Patient Information, including Patient Name, ID, Group No., DOB, and Phone.
Fill in the Prescribing Physician's details: Name, Phone, Fax, Address, City, State, and Zip.
Select the Drug Name from the provided list or specify another. Indicate Quantity, Route of Administration, Frequency, and Expected Length of Therapy.
Answer the questions regarding previous approvals and medication trials. Circle 'Y' for Yes or 'N' for No as applicable.
If applicable, provide supporting documentation for contraindications or quantity-limit exceptions.
Finally, review all information for accuracy and sign with your name and date at the bottom of the form.

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06/04/2013 Prior Authorization AETNA BETTER HEALTH OF PENNSYLVANIA Non -Formulary Medications (PA88) This fax machine is located in a secure location as required by HIPAA regulations-2026

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06/04/2013 Prior Authorization AETNA BETTER HEALTH OF PENNSYLVANIA Non -Formulary Medications (PA88) This fax machine is located in a secure location as required by HIPAA regulations-2026

Here's how it works

How to use or fill out 06/04/2013 Prior Authorization AETNA BETTER HEALTH OF PENNSYLVANIA Non-Formulary Medications (PA88)

See more 06/04/2013 Prior Authorization AETNA BETTER HEALTH OF PENNSYLVANIA Non -Formulary Medications (PA88) This fax machine is located in a secure location as required by HIPAA regulations versions

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Is it safe to sign my 06/04/2013 Prior Authorization AETNA BETTER HEALTH OF PENNSYLVANIA Non -Formulary Medications (PA88) This fax machine is located in a secure location as required by HIPAA regulations electronically?

Can I edit 06/04/2013 Prior Authorization AETNA BETTER HEALTH OF PENNSYLVANIA Non -Formulary Medications (PA88) This fax machine is located in a secure location as required by HIPAA regulations on my phone?

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