meritain health medication prior authorization form dostinex

Q 1 1 6.312 6.307 re BT Q (4) Tj � Prescribers can access the Prior Authorization form via: www.meridianRx.com. /ZaDb 5 Tf BT n H�D��)M��&�� X��6��0*QF�.P*Ccm��3V��q��+>m��9�$��^̣2�(R��v��t�7��? W /ZaDb 5 Tf Meritain Health Leadership ; Working at Meritain Health E�\i\�\� endstream endobj 843 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream BT If you would like to check the status of your Prior Authorization with your authorization ID, please call 855-323-4580. 0.749023 g H�4�=�@D��Sj��G��l��@��&`!��_x(Vü7�JIMC� f endstream endobj 833 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream � 1.738 2.1619 Td ET 0.749023 g W 0 0 Td � n 1��z��M+��]�,��C�f��Q�bQؠT�� ~7T�pt�C�~����\.+��%�B{!��z��7��;~ � �/ W W endstream endobj 936 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream endstream endobj 857 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream f fq3�x8WP}:�S�~T�K��BH��%P ��D�� k�h*�dq��pr �r� 4.815 TL Q endstream endobj 836 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream �@D��)M��ս��A�4�A ]�(X��,��7�a��u�n�"1��ֵ��~��R�O�O��O�,T�1c-�=��V��]X6#~ �0Q q q �@D��)M��m��M�BH��P��yo��j�+��"9�\��|»�W��v��e,0Qw��x��*��0^#> �� ET E�\i\�\� ET f W q H�2�37�402VH�2P0P��3274R�@�(�+��P�P�"n��O�r f BT 0 0 Td endstream endobj 902 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream Authorizations NEW electronic authorization submission coming soon. BT endstream endobj 884 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 0 0 Td n For Medicare Advantage Part B: PHONE: 1-866-503-0857 FAX: 1-844-268-7263 For other lines of business: Please use other form. endstream endobj 821 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream BT f f 0.749023 g �0 r� News & Updates 0 0 Td Our Account Management and Customer Service teams deliver high-quality and responsive customer support for all clients—no matter the size. endstream endobj 881 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream /ZaDb 5 Tf Submit a prior authorization (PA), appeal, or exception request online by using our online form. 4.815 TL /ZaDb 5 Tf H�2�37�402VH�2P0P0�3b3KK��T�4�B.CCS��)\4�+�6��)�K? f 2.0445 2.459 Td E�\i\�\� endstream endobj 820 0 obj <>/Subtype/Form/Type/XObject>>stream BT /ZaDb 5 Tf W 0 0 Td /ZaDb 5 Tf n PLEASE NOTE: The Precertification Request form is for provider use only. H�2�37�402VH�2P0P��3�� BT • MHN is here to talk to you about your telehealth options to better support social distancing through virtual visits. 2.031 2.4715 Td 0 0 Td n Meritain Health’s Utilization Management program meets the medical needs of members while protecting the cost-effectiveness of our clients’ benefits plans. Commercial / ASO Provider Portal Medicare Provider Portal Join Our Network Join a network for commercial providers or access administrative forms, claim information, advanced directives and MHN.com uses cookies. tz>Q2:�j�¹��am8g�tC�(]��=H-� HP0=��v��,� J��@2� �%��a>N��I�)ƞRC�F��7B�-�gr��~t�$f��T�薡��!i��FaR= endstream endobj 830 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 2.0442 2.4595 Td Meritain Health COVID-19 Resources We support you in maintaining health and ensuring access to care /ZaDb 5 Tf : The Precertification Request form is for provider use only. q 0.749023 g H�4�� 2.0411 2.4765 Td ��!P�l0��a��` �X 0 0 Td f E�\i\�\� 4.815 TL 4.815 TL � 0 0 Td endstream endobj 908 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream endstream endobj 887 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream n 0 0 8.2922 8.307 re Q ��!P�l.��a��` ��- 1 1 5.6838 5.703 re MEDICARE FORM Viscosupplementation Injectable Medication Precertification Request Page 1 of 2 (All fields must be completed and legible for Precertification Review.) fq3�x8WP}:�S�~T�K��BH��%P ��D�� k�h*�dq��pr �� News & Updates 1 1 6.313 6.303 re n endstream endobj 873 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream n Electronic Medical Request Form. 0 0 8.316 8.304 re 1.7185 2.1865 Td (4) Tj f`a3�p8WPu:�S�~T�K��BH��%��e�gad�� 5L4B��\C�� X ET f BT E�\i\�\� q n BT �qS�x8WP}:�S�~T�K��BH��BH BT f H�4�� Q BT ��!P�l4��a��` �� W 0 0 Td 1.734 2.1578 Td endstream endobj 938 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream 4.815 TL BT 1 1 6.317 6.303 re ET 0 0 8.328 8.314 re /ZaDb 5 Tf ET H�2�37�402VH�2P0P��364�& 2.0335 2.4595 Td q Log into our provider portals and access additional resources. endstream endobj 939 0 obj <>/ProcSet[/PDF/Text]>>/Subtype/Form/Type/XObject>>stream ET f`Q3�h8WPm:�S�~T�K��BH��P�H��(��e�gad��5L4B��\C�� I H�2�37�402VH�2P0P��36� �� 1.7269 2.159 Td f /ZaDb 5 Tf The Submit Prior Authorization page will display. If we identify these high-risk cases early, we can begin to actively manage members earlier, greatly increasing our potential for cost savings.Copyright 2015 Meritain Health. Meritain Health Pharmacy Solutions (MPS) is our high-quality pharmacy benefit offering, which focuses on lowering total cost of care and improving clinical outcomes. (4) Tj For a list of drugs covered under your patient’s plan, step therapy and prior authorization criteria, and information about coverage determination requests, view or download a copy of the documents below.