Step 8-Form Details

TABLE OF CONTENTS

• Enter Form Details
• See an Error On the Form? 
• Fear not! If you need assistance sooner, please reach via our chat widget to speak with a live agent and we will attempt to prioritize this request!
• Additional Attachments
  • Example View
• Select "Next" and Attach a Cover Letter
  • Example View
• Guide me to Step 9-Review, Sign & Submit

Enter Form Details

• Fill out all applicable fields for your prior authorization request.
• Utilize the legend to determine required, important, default and filled/low priority fields.
  • All required fields must be fille din to move forward with the authorization. 

See an Error On the Form? 

• Click the link to send the error to the team for review.

• Select from the following options:
  • Tagged Incorrectly
  • This is an outdated form
  • Other (Add details)

• Once you report the error, you should see a notification in the top, right corner of the screen that the error has been reported. Our team attempts to have all form errors reported reviewed and resolved within 2 business days. You will receive an email from a member of our team providing the status of your request.

Fear not! If you need assistance sooner, please reach via our chat widget to speak with a live agent and we will attempt to prioritize this request!

Select "Continue to Cover Letter"

• By default, the option to include a cover letter will be pre-selected. 
  • You also have the option to add notes, which is optional. 
  • By selecting "Edit Cover Letter," you can review all cover letter details and make any necessary corrections to the pre-populated information. 
• If you prefer to proceed without a cover letter, simply deselect the option to include it.

Importance of a Cover Letter
We suggest attaching a cover letter to provide:
-Ease with payers when reviewing your authorizations.
-Accuracy in attaching your response from the payer back to the authorization in SamaCare.

(The QR code at the bottom of the letter helps us identify the exact authorization the response is related to when faxed back from the payer). 

Additional Attachments

• You can attach documents to your prior authorization request by uploading a PDF.

Example View

Guide me to Step 9-Review, Sign & Submit

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