Step 1-Gathering Information to Submit

• Patient Demographics
• Drug Code(s)
• Start Date of Service
• Request Type
• ICD-10 Code(s)
• Provider Details
• Location Details
• Guide me to Step 2-Starting a New Authorization

You will need certain information to begin submitting your form authorization. Below are the details you will need in order to fill out and submit your prior authorization successfully. Be sure to have the member ID card in hand!

Patient Demographics

• First and Last Name of the patient.
• Patient date of birth.
• Patient address.

If you are integrated with one of our supported EMR/EHR integrations, your patients will be available in real time. See more about our available integrations here!

Drug Code(s)

• HCPCS
• Quantity

Patient Insurance Information

• Insurance Type
  • Medicare
  • Medicaid
  • Commercial
  • Other
• Member ID
• Issuing State
• Insurance Organization

You can locate all of the patient information needed for this section just by having the patients member ID card in hand!

Start Date of Service

• The date that you wish to have the service starting on to provide to the insurance payer for review. 

Request Type

• Expedited?
• New or continuation request?
  

ICD-10 Code(s)

• All diagnosis codes related to your prior authorization request. 

Provider Details

• First and Last Name
• NPI

Once a provider has been entered and saved in your practice settings, each provider will be available in the drop down list for faster submission! See steps on how to add saved providers here!

Location Details

• Facility Name
• Address
• Office NPI

Once a location has been entered and saved in your practice settings, each location will be available in the drop down list for faster submission! See steps on how to add saved locations here!

Guide me to Step 2-Starting a New Authorization

We're here to guide you through your prior authorization quest!