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What is Needed?

For a prior authorization request we need four pieces of information.




1. Patient Demographics

At a minimum we need the following information:

  • First and last name
  • Date of birth
  • Full address (Street, City, State, Zip)

The phone number is not required, but can be very helpful if the patient is not identified by the insurance company. 




2. Prescriber Information

We have a list of