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General Information for Authorization - Wa

General Information for Authorization Org 1. Service Type 2. Client Information Name 3. Client ID 4. Living Arrangements 5. Reference Auth # 6. Provider Information Requesting NPI # 7.

DTS for Diabetic Testing Supplies (See Pharmacy Billing Instructions for POS Billing) ... Instructions to fill out the General Information for Authorization form, HCA 13-835 : FIELD NAME ACTION ALL FIELDS MUST BE TYPED. 2 : Service Type ... For Prior Authorization (PA) requests when the client ID is unknown (e.g. client eligibility

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www.hca.wa.gov

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Authorization status use keypad only

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Authorization status – use keypad only Dial 1-800-562-3022 Select 1 for English or stay on the line “If you have an extension, press 1 now.” Select 2 for self-service provider menu Select 1 for authorization Select 1 for pharmacy authorizations

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Early and Periodic Screening, Diagnosis and …

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www.hca.wa.gov

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Prior Authorization Form General/Non-Preferred Drugs Access this PA form at: ... Buprenorphine Products Celebrex Compounds Daklinza Diabetic Supplies Dipeptidyl-Peptidase IV Inhibitors Growth Hormones Harvoni High Potency Statins Incretin Mimetics Influenza Antivirals I/DD Worksheet Long Acting Narcotics

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