Humana RightSourceRx Home Delivery Prescription Guide
This file provides a comprehensive guide to Humana's RightSourceRx home delivery prescription service. It includes instructions for prescribing, payment options, and key contact information. Ideal for healthcare providers and Humana-insured patients.
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How do I fill this out?
To complete this form, gather all necessary information about the patient and prescriber. Ensure the prescription details are accurate and fax the completed form to RightSourceRx. Follow the instructions provided on the form for seamless processing.
How to fill out the Humana RightSourceRx Home Delivery Prescription Guide?
1
Gather patient and prescriber information.
2
Fill out the member and prescriber details accurately.
3
Complete the prescription information section.
4
Sign and date the form.
5
Fax the form to RightSourceRx at the provided number.
Who needs the Humana RightSourceRx Home Delivery Prescription Guide?
1
Healthcare providers needing to prescribe a medication with home delivery for Humana-insured patients.
2
Patients looking for a convenient and cost-effective prescription medication service.
3
Pharmacy staff coordinating prescription requests for Humana members.
4
Medicare members seeking cost savings with Tier 1 generic prescriptions.
5
Patients in state pharmaceutical assistance programs.
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What are the instructions for submitting this form?
To submit this form, you must complete all required fields accurately. Gather the patient's member information, prescriber details, and prescription information. Once filled, sign and date the form. Fax it to RightSourceRx at 1-800-379-7617. Ensure all information is correct to avoid delays in processing. For questions or assistance, contact RightSourceRx Customer Care at 1-800-379-0092.
What is the purpose of this form?
The purpose of this form is to facilitate the accurate and convenient ordering of prescription medications through Humana's RightSourceRx home delivery service. By using this form, healthcare providers ensure that prescriptions are reviewed for accuracy and safety before being delivered to the patient's home. This process helps reduce prescription drug costs and provides a seamless experience for both healthcare providers and patients.
Tell me about this form and its components and fields line-by-line.
- 1. Member ID: The unique identifier found on the Humana ID card.
- 2. First Name: The patient's first name.
- 3. Last Name: The patient's last name.
- 4. Date of Birth: The patient's date of birth in MM/DD/YYYY format.
- 5. Gender: The patient's gender (Male or Female).
- 6. Street Number and Name: The patient's residential address.
- 7. Apt/Suite #: Additional address details if applicable.
- 8. City: The city where the patient resides.
- 9. State: The state where the patient resides.
- 10. ZIP Code: The postal code of the patient's address.
- 11. Phone Number: The patient's contact phone number.
- 12. Allergies: Any known allergies the patient has (e.g., Aspirin, Codeine, Penicillin, Peanuts, Sulfa, Other).
- 13. Prescription Information: Details of the prescribed medication, including drug name, strength, directions, quantity, and number of refills.
- 14. Prescriber Information: Details of the prescribing physician, including first name, last name, DEA number, NPI number, address, phone number, and fax number.
- 15. Prescriber Signature: The signature of the prescribing physician along with the date.
What happens if I fail to submit this form?
Failure to submit this form may result in delayed or missed medication deliveries for the patient. This can lead to interruptions in treatment and potential health risks.
- Delayed Medication Delivery: Patients may not receive their medication on time, which can affect their treatment schedule.
- Missed Treatments: Failure to receive medication can result in missed treatments and potential health risks.
- Increased Costs: Delays in medication delivery might lead to increased costs for both patients and healthcare providers.
How do I know when to use this form?
- 1. Prescription Medication: When a patient needs a new prescription or a refill for their medication.
- 2. Cost Savings: To take advantage of cost-saving options like 90-day pricing or Tier 1 generic prescriptions.
- 3. Convenient Delivery: When patients prefer to receive their medications through home delivery.
- 4. Accurate Reviews: To ensure prescriptions are reviewed for accuracy and safety by RightSourceRx pharmacists.
- 5. State Program Coordination: For patients in state pharmaceutical assistance programs to verify coordination with RightSourceRx.
Frequently Asked Questions
How do I fill out this form?
Gather all necessary patient and prescriber information, complete each section accurately, sign and date the form, then fax it to RightSourceRx.
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Use PrintFriendly's sharing options to send the document via email or generate a shareable link for easy distribution.
What information do I need to gather before filling out the form?
Ensure you have all necessary patient and prescriber information, including member ID, allergies, prescription details, and contact information.
Where do I send the completed form?
Fax the completed form to RightSourceRx at the provided fax number.
Can patients fax their own prescriptions?
No, only physicians can fax prescriptions to RightSourceRx.
How do I know if a generic substitute is available?
RightSourceRx will dispense an FDA-approved generic equivalent whenever available and permitted by the prescriber.
What payment options are available?
RightSourceRx offers several payment options, including the HumanaAccess Visa Debit Card, major credit cards, personal checks, or money orders.
How do I get additional fax forms?
Additional fax forms are available online at RightSourceRx.com.
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