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How do I fill this out?
Filling out this form requires careful attention to detail. Ensure you complete all sections fully to avoid delays in processing your request. Follow the step-by-step instructions provided within the form.
How to fill out the Anthem HealthKeepers Plus Pharmacy Prior Authorization?
1
Complete the member information section accurately.
2
Fill out the medication information, including drug name and dosage.
3
Ensure the prescriber information section is completed.
4
Attach any required supporting documents as instructed.
5
Submit the form via fax to expedite the request.
Who needs the Anthem HealthKeepers Plus Pharmacy Prior Authorization?
1
Healthcare providers need this form to request medication approval.
2
Patients require this form to ensure their prescribed medications are covered.
3
Pharmacies use this form to verify medication authorizations for patients.
4
Insurance agents may need this form to facilitate coverage discussions.
5
Clinical staff need this form to document medication requests for compliance.
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What are the instructions for submitting this form?
To submit the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form, fax the completed document to 844-512-7020 for retail pharmacy or 844-512-7022 for medical injectables. Ensure to include all necessary supporting documentation to avoid delays. For additional assistance, contact Anthem HealthKeepers Plus Provider Services at 800-901-0020.
What are the important dates for this form in 2024 and 2025?
Important dates related to the use of this form may vary annually. Check for any changes each year regarding Medicaid benefits. Updates will be provided by Anthem HealthKeepers Plus.
What is the purpose of this form?
The purpose of the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form is to ensure that medications prescribed to patients are pre-approved for coverage. This process is essential to confirm the medical necessity of the treatment. Ultimately, this form helps maintain compliance with HealthKeepers, Inc. guidelines.
Tell me about this form and its components and fields line-by-line.
- 1. Member Information: Includes member's name, ID, and details about residence.
- 2. Medication Information: Requires drug name, dosage, and diagnosis.
- 3. Prescriber Information: Captures the prescriber's details including signature.
- 4. Billing Facility: Includes billing facility's contact and address details.
- 5. Pharmacy Information: Collects pharmacy name and NPI number.
What happens if I fail to submit this form?
Failing to submit this form can lead to delays in medication approval. It may result in patients having to pay out-of-pocket for prescribed treatments. Additionally, it could impact health outcomes by delaying necessary care.
- Processing Delays: Incomplete forms will cause prolonged approval times.
- Treatment Delays: Patients may miss required treatments if authorization is not obtained.
- Financial Implications: Not having authorization could lead to unexpected costs for patients.
How do I know when to use this form?
- 1. Initial Prescription Submission: Submit this form when a new medication is prescribed that requires prior authorization.
- 2. Change in Medication: Use this form if there’s a change in prescribed medication that may need approval.
- 3. Refill Requests: Employ this form for refill requests on medications that require prior authorization.
Frequently Asked Questions
What is the purpose of this form?
This form is used to request prior authorization for pharmacy services under Anthem HealthKeepers Plus.
Who can fill out this form?
Healthcare providers, patients, and pharmacies can fill out this form.
How do I submit the form?
You can submit the form via fax to the specified numbers provided in the instructions.
What should I do if my request is denied?
Check the reasons for denial and consider resubmitting with additional information.
Can I edit the PDF online?
Yes, you can edit the PDF using PrintFriendly’s editing features.
How can I share this form with others?
You can share this form via email or by generating a shareable link.
Is there a way to sign this PDF electronically?
Yes, you can add an electronic signature directly on PrintFriendly.
What information do I need to provide?
You'll need member information, medication details, and prescriber information.
How long does it take for approval?
Please allow at least 24 hours for review of your request.
Where can I find the preferred drug list?
Visit the Anthem HealthKeepers Plus provider website for the preferred drug list.
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