Anthem HealthKeepers Plus Pharmacy Prior Authorization Form
This file contains the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form required for processing medication requests under Medicaid. It provides essential instructions, member information, and necessary fields to be completed accurately for medical necessity review. Utilize this form to ensure timely authorization of medication prescribed.
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How do I fill this out?
Filling out this prior authorization form is crucial for ensuring that your medication requests are processed without delay. Carefully read the instructions and provide all requested information accurately. Completing the form in its entirety will help expedite the authorization process.
How to fill out the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form?
1
Read the instructions carefully before starting to fill out the form.
2
Provide complete member and medication information as requested.
3
Include all necessary codes and supporting documents for medical necessity.
4
Send the completed form via fax to the designated numbers.
5
Allow 24 hours for a response regarding your authorization request.
Who needs the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form?
1
Patients requiring new medications under Medicaid must complete this form for authorization.
2
Healthcare providers need to submit this form to request medication approvals for their patients.
3
Pharmacies must use this form when seeking authorization for medications not covered under the standard benefits.
4
Prescribers who need to document medical necessity for medication should fill out this form.
5
Clinical staff assisting patients with medication requests should be familiar with this form to provide guidance.
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What are the instructions for submitting this form?
To submit the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form, you can fax the completed document to the designated fax numbers: 844-512-7020 for retail pharmacy or 844-512-7022 for medical injectables. Ensure that all sections are fully completed to avoid delays. For any queries, reach out to Anthem HealthKeepers Plus Provider Services at 800-901-0020.
What are the important dates for this form in 2024 and 2025?
Important dates for the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form include submission deadlines and renewal dates relevant to member eligibility for Medicaid benefits. It's crucial to stay informed about any updates regarding Medicaid policies that may affect the authorization process. Regularly check the official HealthKeepers website or contact Provider Services for more information.
What is the purpose of this form?
The Anthem HealthKeepers Plus Pharmacy Prior Authorization Form serves as a vital document for obtaining approval for prescribed medications under Medicaid. Its primary purpose is to ensure that medication requests are reviewed based on medical necessity, which helps to maintain compliance with Medicaid regulations. By providing a structured process for submitting and reviewing requests, the form facilitates timely access to essential medications for eligible members.
Tell me about this form and its components and fields line-by-line.
- 1. Member Information: This section requires the last name, first name, member ID, and other personal details to identify the patient.
- 2. Medication Information: Details about the requested drug, dosage, and diagnosis must be provided for a thorough review.
- 3. Prescriber Information: The prescriber's details, including name and contact information, are needed for validation.
- 4. Pharmacy Information: This section collects the pharmacy's name and contact details for processing requests.
- 5. Signature: A section for the prescriber to sign and date, certifying the accuracy of the provided information.
What happens if I fail to submit this form?
If the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form is not submitted correctly or is incomplete, it may lead to delays in medication approval. A lack of proper documentation can hinder the review process, and the pharmacy may not be able to dispense the requested medication. It's essential to ensure all required sections are filled out to avoid these issues.
- Processing Delays: Incomplete forms can result in significant delays in obtaining necessary medications for patients.
- Denial of Coverage: Failure to provide adequate information may lead to denial of medication coverage.
- Increased Workload: Incomplete submissions can cause additional workload for healthcare providers and pharmacies.
How do I know when to use this form?
- 1. When a Medication is Non-Preferred: Use this form to request approval for medications that are not listed as preferred in the drug formulary.
- 2. For Medical Injectable Medications: This form is needed to authorize injectable medications that need prior approval.
- 3. If Member has Try and Failure History: Use the form if the member has previously tried other medications without adequate response.
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