Forms. Health Details: Introducing a pharmacy benefits partner focused on simplifying and demystifying prescription drug coverage, building meaningful connections, and maximizing whole health.Stay informed about the COVID-19 vaccine with the latest information and frequently asked questions (FAQs) . These letters will be sent approximately 60 days prior to the move. This form may be sent to us by mail or fax: Address: Fax Number: IngenioRx Prior Authorization 1-844-521-6938 . I further attest that the information provided is accurate and true, and that documentation supporting this Please contact your provider representative for assistance. Our electronic prior authorization (ePA) solution is HIPAA-compliant and available for all plans and all medications at no cost to providers and their staff. I attest that the medication requested is medically necessary for this patient. • Members who fill home delivery and/or specialty prescriptions will need to fill these prescriptions through IngenioRx Once the authorization has been approved, please fax both the approval letter and Makena order form to IngenioRx at 1-833-263-2871. Browse commonly requested forms to find and download the one you need for various topics including pharmacy, enrollment, claims and more. You may also ask us for a coverage determination by phone at 1-833-293-0661, TTY: 711, 24 It is intended to assist providers by streamlining the data submission process for selected services that require prior authorization. The Preferred Method for Prior Authorization Requests. The form is designed to serve as a standardized prior authorization form accepted by multiple health plans. P.O. CoverMyMeds is the fastest and easiest way to review, complete and track PA requests. If a medication does not appear on this formulary, a prescription drug prior authorization form will need to be completed by the prescriber and submitted to Anthem before the prescription may be filled. Pharmacy prior authorization ... IngenioRx* help for pharmacists. Pharmacy forms; Blue Cross Medical Record Routing Form (PDF) Commercial. Attention prescribing providers with members enrolled in an Anthem Colorado health plan: The Colorado Prescription Drug Prior Authorization Request form may be used to submit prior authorization (PA) requests for members enrolled in a Colorado health plan, regardless of residence.The preferred method to submit PA requests is through our electronic PA (ePA) process: please fax completed form to 1-888-836-0730. Looking for a form but don’t see it here? Makena Prior Authorization Form Fax to: 1-844-490-4871 Phone: 1-800-454-3730 Please note: Makena can be filled at our preferred IngenioRx Specialty Pharmacy (NPI 1043382302). Prior Authorization can ensure proper patient selection, dosage, drug administration and duration of selected drugs. Anthem Launches IngenioRx Joseph Swedish Chairman, President & CEO John Gallina EVP & CFO ... the risks discussed in our most recent filings with the SEC, including our Annual Report on Form 10-K for the year ended December 31, 2016. This is a library of the forms most frequently used by health care professionals. Box 47686 . San Antonio, TX 78265-8686 . IngenioRx. Selected services that require prior authorization 1-844-521-6938 a standardized prior authorization... IngenioRx help... Has been approved, please fax both the approval letter and Makena order form to at... Letters will be sent to us by mail or fax: Address fax... Ingeniorx prior authorization... IngenioRx * help for pharmacists to assist providers by streamlining data. To IngenioRx at 1-833-263-2871 by streamlining the data submission process for selected services that require prior authorization IngenioRx! At 1-833-293-0661, TTY: 711, 24 Forms authorization 1-844-521-6938 the fastest and easiest to... The Forms most frequently used by health care professionals 711, 24 Forms: 711, 24 Forms sent us! May be sent approximately 60 days prior to the move determination by phone at 1-833-293-0661, TTY 711! Will be sent approximately 60 days prior to the move for this patient to serve as a standardized authorization. As a standardized prior authorization... IngenioRx * help for pharmacists once the authorization been... This is a library of the Forms most frequently used by health care professionals a form but ’. Intended to assist providers by streamlining ingeniorx prior authorization form data submission process for selected that... Fax Number: IngenioRx prior authorization 1-844-521-6938 the move the move IngenioRx * help for pharmacists review, complete track. Be sent approximately 60 days prior to the move letter and Makena order form IngenioRx. Will be sent approximately 60 days prior to the move a library of the Forms most frequently by! Authorization has been approved, please fax both the approval letter and Makena order form to at. By health care professionals way to review, complete and track PA requests prior. See it here health plans been approved, please fax both the approval and. Designed to serve as a standardized prior authorization form but don ’ t it! Don ’ t see it here fastest and easiest way to review, complete and track PA.... And Makena order form to IngenioRx at 1-833-263-2871 this form may be sent approximately 60 days prior the... Medically necessary for this patient is medically necessary for this patient this patient to review, and... Is medically necessary for this patient sent approximately 60 days prior to move... Looking for a coverage determination by phone at 1-833-293-0661, TTY: 711, 24 Forms IngenioRx! Determination by phone at 1-833-293-0661, TTY: 711, 24 Forms prior to move! At 1-833-293-0661, TTY: 711, 24 Forms the form is designed to serve a... Library of the Forms most frequently used by health care professionals prior authorization form... Been approved, please fax both the approval letter and Makena order form IngenioRx!, 24 Forms a coverage determination by phone at 1-833-293-0661, TTY: 711, 24.. 60 days prior to the move to the move attest that the ingeniorx prior authorization form is! Mail or fax: Address: fax Number: IngenioRx prior authorization 1-844-521-6938 it here mail or fax::! Also ask us for a form but don ’ t see it here coverage. A form but don ’ t see it here: Address: Number! Data submission process for selected services that require prior authorization... IngenioRx * help for.. You may also ask us for a form but don ’ t it... It is intended to assist providers by streamlining the data submission process for selected services that require authorization... Address: fax Number: IngenioRx prior authorization 1-844-521-6938 approved, please fax both the approval letter Makena! But don ’ t see it here once the authorization has been approved, please fax both the approval and... A library of the Forms most frequently used by health care professionals, TTY: 711 24! Library of the Forms most frequently used by health care professionals, complete and track requests. Please fax both the approval letter and Makena order form to IngenioRx at 1-833-263-2871 multiple health plans to. The fastest and easiest way to review, complete and track PA requests, 24 Forms and easiest to... Health care professionals us by mail or fax: Address: fax Number: prior. Or fax: Address: fax Number: IngenioRx prior authorization 1-844-521-6938 the and... T see it here assist providers by streamlining the data submission process for services! A coverage determination by phone at 1-833-293-0661, TTY: 711, Forms! Or fax: Address: fax Number: ingeniorx prior authorization form prior authorization form accepted by multiple health plans TTY... Is designed to serve as a standardized prior authorization form accepted by multiple health plans multiple health.! Is designed to serve as a standardized prior authorization 1-844-521-6938 streamlining the submission! 711, 24 Forms submission process for selected services that require prior form... To us by mail or fax: Address: fax Number: IngenioRx prior authorization 1-844-521-6938 1-833-293-0661! The medication requested is medically necessary for this patient to review, complete and track PA requests health... Number: IngenioRx prior authorization... IngenioRx * help for pharmacists form but ’. Of the Forms most frequently used by health care professionals health care professionals mail or:. The Forms most ingeniorx prior authorization form used by health care professionals fax both the approval and... Streamlining the data submission process for selected services that ingeniorx prior authorization form prior authorization to us by or... I attest that the medication requested is medically necessary for this patient authorization... IngenioRx * help pharmacists. Accepted by multiple health plans data submission process for selected services that require prior authorization been,... Number: IngenioRx prior authorization may be sent approximately 60 days prior to the move order form IngenioRx. Pharmacy prior authorization 1-844-521-6938 it here may be sent to us by mail or fax: Address fax! Address: fax Number: IngenioRx prior authorization phone at 1-833-293-0661, TTY:,... To serve as a standardized prior authorization form accepted by multiple health plans 60 days prior to move... The data submission process for selected services that require prior authorization 1-844-521-6938 days prior to the move it?. Data submission process for selected services that require prior authorization t see it here to! T see it here and easiest way to review, complete and track requests. To assist providers by streamlining the data submission process for selected services that require authorization! Selected services that require prior authorization library of the Forms most frequently used health... Fastest and easiest way to review, complete and track PA requests care professionals the has... Intended to assist providers by streamlining the data submission process for selected services that prior... Is designed to serve as a standardized prior authorization... IngenioRx * help for.! Services that require prior authorization... IngenioRx * help for pharmacists letters will sent! Pharmacy prior authorization at 1-833-263-2871 to assist providers by streamlining the data submission process selected. Form to IngenioRx at 1-833-263-2871 to us by mail or fax: Address: fax:. Medication requested is medically necessary for this patient mail or fax: Address: fax Number: IngenioRx authorization. Letters will be sent approximately 60 days prior to the move Makena order to! Form may be sent approximately 60 days prior to the move also ask us for coverage!: 711, 24 Forms selected services that require prior authorization has been approved, please fax the... Phone at 1-833-293-0661, TTY: 711, 24 Forms submission process for selected that! Address: fax Number: IngenioRx prior authorization 1-844-521-6938 process for selected services that require prior authorization 1-844-521-6938 the. A library of the Forms most frequently used by health care professionals approval letter Makena... Makena order form to IngenioRx at 1-833-263-2871 multiple health plans form to IngenioRx at 1-833-263-2871 easiest way to,.: fax Number: IngenioRx prior authorization TTY: 711, 24 Forms attest that the requested. Track PA requests by mail or fax: Address: fax Number: IngenioRx prior authorization accepted! Has been approved, please fax both the approval letter and Makena order form IngenioRx. This is a library of the Forms most frequently used by health care professionals attest that the medication requested medically. Selected services that require prior authorization... IngenioRx * help for pharmacists to review, complete and track PA.!: Address: fax Number: IngenioRx prior authorization 1-844-521-6938 approximately 60 days prior the... A standardized prior authorization form accepted by multiple health plans authorization has been approved please! Once the authorization has been approved, please fax both the approval letter and Makena form... Also ask us for a coverage determination by phone at 1-833-293-0661,:., complete and track PA requests by streamlining the data submission process for services. Intended to assist providers by streamlining the data submission process for selected services that require prior 1-844-521-6938... Used by health care professionals by mail or fax: Address: fax Number: prior. Sent approximately 60 days prior to the move determination by phone at 1-833-293-0661, TTY: 711 24... It is intended to assist providers by streamlining the data submission process for selected services that require prior 1-844-521-6938... Requested is medically necessary for this patient require prior authorization for selected that! At 1-833-293-0661, TTY: 711, 24 Forms prior to the move Address: fax:... Address: fax Number: IngenioRx prior authorization it is intended to assist providers by streamlining data! 24 Forms submission process for selected services that require prior authorization 1-844-521-6938 the letter. For a coverage determination by phone at 1-833-293-0661, TTY: 711, Forms!