Aetna Better Health Louisiana Pharmacy Prior Authorization Form. This file contains the Aetna Better Health of Louisiana prior auth
This file contains the Aetna Better Health of Louisiana prior authorization form to be used for medical requests. Prior authorization is required for select medications. Aetna complies with applicable Federal civil rights laws and does not unlawfully discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, or disability. Member Services 1‐855‐242‐0802 (TTY: 711) available 24 hours a day/7 days a week Please use the following address when submitting claims to Aetna Better Health of Louisiana Aetna Better Health of Louisiana P. Prior authorization How to obtain prior authorization As an Aetna Better Health provider, you need to prescribe medically necessary therapy or medications for a member. Is there any Did you know that you can use our provider portal Availity® to submit prior authorization request, upload clinical documentation, check statuses, and make changes to existing requests? LOUISIANA SINGLE UNIFORM PRESCRIPTION DRUG PRIOR AUTHORIZATION FORM For FASTEST service, call 1-855-240-0535, Monday-Friday, 8 a. Also, by signing and submitting this request form, the prescriber attests to statements in the ‘Attestation’ section of the criteria specific to this request, if applicable. Louisiana Department of Health Bureau of Health Services Financing PRIOR AUTHORIZATION REQUEST COVERSHEET Please check the member’s appropriate health plan listed below: Aetna Better Health of Louisiana Phone: 1-855-242-0802 Fax: 1-844-699-2889 Prior authorization is required for select medications. Learn more about what services require prior authorization. DentaQuest performs Dental Utilization management services on behalf of Aetna Better Health of Louisiana. Please contact DentaQuest for prior authorization and benefit information of these Providers, get materials and forms such as the provider manual and commonly used forms. Prior authorization is required for select, acute outpatient services and planned hospital admissions. Central Time Prior authorization is required for some medications. Page 1 of 2 Pharmacy Prior Authorization Request Form 6. Box 61808 Phoenix, AZ 85082-1808 For resubmissions, please completed prior authorization request form to 855-799-2553 or submit Electronic Prior Authorization CoverMyMeds® or SureScripts. Learn how to request prior authorization here. to 6 p. m. Providers, get materials and forms such as the provider manual and commonly used forms. Pharmacies are allowed to dispense a 72 hour emergency supply while authorization is pending. REQUIRED: Office notes, labs, and medical testing relevant to the request that show medical justification are required. You can also learn about our pharmacy PA guidelines. Page 1 of 2 Pharmacy Prior Authorization completed prior authorization request form to 855-799-2554 or submit Electronic Prior Authorization through CoverMyMeds® or SureScripts. Providers, get materials and forms such as prior authorization, waiver of liability and more. Forms are updated frequently. Box 61808 Phoenix, AZ 85082-1808 For resubmissions, please . AETNA BETTER HEALTH® OF LOUISIANA Prior authorization form Phone: 1-855-242-0802 Physical Health Fax: 1-844-227-9205 AETNA BETTER HEALTH® OF LOUISIANA Prior authorization form Phone: 1-855-242-0802 Physical Health Fax: 1-844-227-9205 Contact the Aetna Better Health Pharmacy Prior Authorization team at 1-866-212-2851 if you would like a service authorization request form faxed to you. Some of these services require Please use the following address when submitting claims to Aetna Better Health of Louisiana Aetna Better Health of Louisiana P. O. It covers member and provider information, referral Prior authorization is required for select, acute outpatient services and planned hospital admissions. These are fax forms for drugs in our prior Prior authorization is required for some medications. Aetna Better Health of Louisiana Phone: 1-855-242-0802 Fax: 1-844-699-2889 Some health care services require prior authorization or preapproval first. Providers can find out what services require prior authorization or check on the status of an authorization.
