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RxResource Home > Pharmacy Resources > Pharmacy Benefit Management
2441 Warrenville Road, Suite 610 Lisle, IL 60532-3642
Susan Fleming, Vice President, Marketing
Phone: (630) 577-4880
http://www.catamaranrx.com/
Catamaran offers a true alternative to the status quo in pharmacy benefit management. You don't have to choose between the scale and purchasing power of the largest providers and the flexibility and agility of smaller ones. We offer the best of both.
At Catamaran, we put your individual needs - and those of your members - at the center of our services. We connect pharmacists, doctors and caregivers with prescription data to improve health outcomes, offering the clinical intelligence, technology and scale to lower payer costs while improving member health.
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Printable Catamaran Prior Auth Form
The Catamaran Prior Auth Form is a way for sailors to get pre-authorized. This will make it easier to rent equipment, such as catamarans, sailing boats and dinghies in advance. The forms are also useful if you want
The Catamaran Prior Auth Form is the official document that must be completed in order to get prior authorization for a Catamaran. This form is used by patients who are enrolled in Medicare, Medicaid, or any other government funded plan. The patient's insurance company will need this form in order to provide coverage for the procedure. The Catamaran Prior Auth Form has two sections: one labeled "Reason For Authorization" and one labeled "Description of Services." These sections are where the patient lists information about their condition and why they require treatment with a catamaran procedure respectively. It's important that both sections are filled out completely before submission to avoid delays with processing time or potential denial of services altogether.
Document Preview
Prior Authorization Form
Provigil®/Nuvigil®
***All PA forms may be found by accessing https://tnm.providerportal.sxc.com/rxclaim/TNM/PAs.htm ***
If the following information is not complete, correct, or legible the PA process can be delayed. Use one form per member please.
Member Information
Prescriber Information
Date of Birth
REQUESTED ANTIHYPERKINESIS AGENT
Dose ___________ Directions __________________________________ Qty ________ Duration of Therapy ________
1. What is the diagnosis for this medication?
If yes , how long has the recipient been taking the medication?
How has medication been supplied (other insurance, samples provided, patient discharged from hospital on the medication, etc.)?
___________________________________________________________________________________________________________
If no , what is the reason the patient cannot take Provigil? _____________________________________________________________
TennCare Prior Authorization Form: Provigil®/Nuvigil™
Complete this section only if diagnosis is shift work sleep disorder .
8. Does the patient work a minimum of 6 hours work between the hours of 10 pm and 8 am?
Please note any other information pertinent to this PA request:
(By signature, the physician confirms the above information is accurate and verifiable by patient records.)
Fax This Form to: 866-434-5523
Mail requests to: Catamaran PA Department, P.O. Box 3214, Lisle IL 60532-8214
Telephone 866-434-5524
Catamaran will provide a response within 24 hours day upon receipt.
This facsimile transmission contains legally privileged and confidential information intended for the parties identified below.
If you have received this transmission in error, please immediately notify us by telephone and return the original message to P.O. Box 3214; Lisle, IL 60532-8214.
Distribution, reproduction or any other use of this transmission by any party other than the intended recipient is strictly prohibited.
You might be interested in these other forms: Coventry Prior Auth Form Medication , C 4 Auth Form , Care 1St Arizona Prior Authorization Form , Cigna Prior Auth Form
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Catamaran Prior Auth Form – Fill Out and Use This PDF
The Catamaran Prior Auth Form is a document that contains information about your boat and the people who will be on it. There are two different forms: a short form and an advanced form.
We make sure it is simple and safe to fill out this form. Simply click the orange button down below to adjust your PDF document. Editing this PDF can be easily performed on a smartphone or laptop.
Catamaran Prior Auth Form PDF Details
Catamaran Prior Auth Form is a form for requesting prior authorization from an insurance company. This form is often used when the patient needs to have surgery and their insurance provider requires such documentation before agreeing to cover the costs of medical care. The Catamaran Prior Auth Form must be completed with accurate information in order for it to be valid, and can then be submitted electronically or by faxing it back in. The Catamaran Prior Auth Form was developed by Catamaran, a healthcare cost management company that specializes in working with employers and health plans on behalf of their employees and beneficiaries.
In the table, there is some information about the catamaran prior auth form. This figure provides information regarding the form's length, finalization duration, and the parts you will be expected to fill.
Form Preview Example
Prior Authorization Form
Provigil®/Nuvigil®
***All PA forms may be found by accessing https://tnm.providerportal.sxc.com/rxclaim/TNM/PAs.htm ***
If the following information is not complete, correct, or legible the PA process can be delayed. Use one form per member please.
Member Information
Prescriber Information
Date of Birth
REQUESTED ANTIHYPERKINESIS AGENT
Dose ___________ Directions __________________________________ Qty ________ Duration of Therapy ________
1. What is the diagnosis for this medication?
If yes , how long has the recipient been taking the medication?
How has medication been supplied (other insurance, samples provided, patient discharged from hospital on the medication, etc.)?
___________________________________________________________________________________________________________
TennCare Prior Authorization Form: Provigil®/Nuvigil™
Complete this section only if diagnosis is shift work sleep disorder .
8. Does the patient work a minimum of 6 hours work between the hours of 10 pm and 8 am?
Please note any other information pertinent to this PA request:
(By signature, the physician confirms the above information is accurate and verifiable by patient records.)
Fax This Form to: 866-434-5523
Mail requests to: Catamaran PA Department, P.O. Box 3214, Lisle IL 60532-8214
Telephone 866-434-5524
Catamaran will provide a response within 24 hours day upon receipt.
This facsimile transmission contains legally privileged and confidential information intended for the parties identified below.
If you have received this transmission in error, please immediately notify us by telephone and return the original message to P.O. Box 3214; Lisle, IL 60532-8214.
Distribution, reproduction or any other use of this transmission by any party other than the intended recipient is strictly prohibited.
How to Edit Catamaran Prior Auth Form Online for Free
This PDF editor was built to be as straightforward as possible. Since you try out the following steps, the procedure for creating the Backdate document will undoubtedly be easy.
Step 1: Get the button "Get Form Here" and then click it.
Step 2: When you get into our Backdate editing page, there'll be lots of the options you can undertake about your template at the top menu.
Complete all of the following sections to create the document:
The application will require you to complete the What is the diagnosis for this, Narcolepsy, ADDADHD, Obstructive sleep apneahypopnea, Shift work sleep disorder, Other, Has the recipient failed an, Yes please list, Drug, Strength, Quantity, Length of trial, Reason for discontinuation of the, Drug, and Strength field.
Determine the relevant particulars in the Has the recipient had a sleep, Yes, No Date of study, Does the provider have evidence, Yes, Total length of therapy, If no use why, continued on next page, Page of, and Revised section.
Within the box TennCare Prior Authorization Form, Patient Name, DOB, Complete this section only if, Does the patient work a minimum, Yes, Please note any other information, Prescriber Signature REQUIRED, Date, and By signature the physician, list the rights and responsibilities of the parties.
Step 3: Press the button "Done". Your PDF form is available to be transferred. You will be able download it to your laptop or send it by email.
Step 4: It is safer to prepare copies of the file. You can rest easy that we won't reveal or see your details.
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Page 1 of 2. Catamaran Prior Authorization Department Phone: 800-626-0072 Fax: 866-511-2202. Attention Healthcare Provider: If you would like to discuss this request with a medical professional, please contact the Prior Authorization Department at 800-626-0072. I understand that Catamaran's use or disclosure of individually identifiable ...
Please Note: Medical Necessity Prior Authorization may be utilized to override both formulary coverage and benefit design restrictions. They are issued at the full discretion of the benefit manager. PRIOR AUTHORIZATION FORM COMPLETE AND FAX TO CATAMARAN™ AT 888-852-1832 MEMBER INFORMATION First Name Last Name Plan
Catamaran prescription prior authorization form 2,075 Downloads (No Ratings Still)Download ... The catamaran's prescription authorization form allows beneficiaries of Catamaran's health insurance to obtain insurance for a prescription drug that is not formula-free or is not usually prescribed as the primary treatment option.
Summary. Catamaran offers a true alternative to the status quo in pharmacy benefit management. You don't have to choose between the scale and purchasing power of the largest providers and the flexibility and agility of smaller ones. We offer the best of both. At Catamaran, we put your individual needs - and those of your members - at the center ...
OptumRx and Catamaran networks include all large national chains as well as many ... Prior authorization 4. My medication requires prior authorization. Will I need to go through this process again? ... • Mail: Mail in your new prescription with a completed order form, available from your member website. You can also send in the refill slip ...
Fax This Form to: 866-434-5523 Mail requests to: Catamaran PA Department, P.O. Box 3214, Lisle IL 60532-8214 Telephone 866-434-5524 Catamaran will provide a response within 24 hours day upon receipt. This facsimile transmission contains legally privileged and confidential information intended for the parties identified below.
Catamaran clinical pharmacists reserve the right to refuse to expedite a prior authorization request if the member's health condition does not meet the definition above. If you believe there is an urgency, please explain the reason for the urgency in the section provided at the bottom of page 2.) Prescriber Information Last Name: DEA/NPI: Phone:
The Catamaran Prior Auth Form is the official document that must be completed in order to get prior authorization for a Catamaran. This form is used by patients who are enrolled in Medicare, Medicaid, or any other government funded plan. The patient's insurance company will need this form in order to provide coverage for the procedure.
Catamaran PBM Help Desk at 1-866-391-1164. Catamaran representatives will be available to provide support during the transition process. If they would like to order a new member ID card, they can call the BCBSRI Customer Service number printed on the back of their old card. Important note: Medicare members must show their new member ID card to
Prior Authorization (PA) is a clinical program designed to help meet these goals. What is Prior Authorization (PA)? Prior Authorization means that approval must be given for certain medications to be covered by your plan. Catamaran works with your doctor or provider to make sure coverage is appropriate. How does a Prior Authorization Program ...
If Yes: Proceed filling out the fax form and submit via fax to Catamaran Prior Authorization Dept. If No: Proceed filling out the fax form and submit via fax to HealthyCT at (855) 817-5696 to obtain a
Prior Authorization Forms | Providers | Optima Health To determine if adenine procedure code require PA fork memberships enrolled in ampere managed service program, real for information about specific PA criteria, processes and procedures, contact the MCE with which the member is enrolled.
Prior Authorization Form General/Non-Preferred Drugs Access this PA form at: This document and others if attached contain information that is privileged, confidential and/or may contain protected health information (PHI). ... Fax this form to 1-866-434-5523 Phone: 1-866-434-5524 OptumRx will provide a response within 24 hours upon receipt.
Authorization form - English PDF Formulario Estándar de Autorización para la Divulgación de Información de Salud Protegida (PHI) (Español) Usamos este formulario para obtener su consentimiento por escrito para divulgar su información de salud protegida (protected health information, PHI) a alguien que usted haya designado.
Handy tips for filling out Catamaran rx prior auth form online. Printing and scanning is no longer the best way to manage documents. Go digital and save time with airSlate SignNow, the best solution for electronic signatures.Use its powerful functionality with a simple-to-use intuitive interface to fill out Catamaran Prior Authorization Form online, e-sign them, and quickly share them without ...
Learn how to fill out and use the Catamaran Prior Auth Form, a document for requesting insurance coverage for medical care. Find out the form details, examples, and online editing tips.
Prior Authorization Guide. Part II Policy & Procedures Manual. Email (preferred) the completed registration form to [email protected] or Fax to 888-292-4814. Members. Register now and learn more about your: Current prescription drugs; Prescription drug history; Co-pays; Pharmacy locations enrolled in Medicaid
Complete Prior Authorization Form - Catamaran in just a couple of minutes by simply following the guidelines below: Select the document template you want from the library of legal forms. Click the Get form button to open it and begin editing. Submit the necessary fields (they will be marked in yellow).
Find the Catamaran Prior Authorization Form you want. Open it up using the cloud-based editor and start adjusting. Fill in the blank fields; engaged parties names, places of residence and phone numbers etc. Change the blanks with smart fillable areas. Add the day/time and place your e-signature. Simply click Done following twice-checking ...
Prior Authorization Process and Criteria. The Georgia Department of Community Health establishes the guidelines for drugs requiring a Prior Authorization (PA) in the Georgia Medicaid Fee-for-Service/PeachCare for Kids® Outpatient Pharmacy Program. To view the summary of guidelines for coverage, please select the drug or drug category from the ...
Catamaran Prior Authorization Form; Prior Authorization Form; Prior Authorization Form . ADVERTISEMENT. 1650 Spring Gate Lane. Las Vegas, NV 89134. Tel: 888-869-4600. Please Note: Medical Necessity Prior Authorization may be utilized to override both formulary coverage and benefit design.
The catamaran prior authorization form is a document used to request approval from Catamaran, a pharmacy benefit manager, for coverage of certain medications or treatments. The form is typically required for medications that are not on the plan's preferred drug list or require additional documentation for coverage.
Complete Catamaran Prior Authorization Form in just a couple of clicks by following the guidelines below: Pick the template you will need from the library of legal forms. Select the Get form button to open the document and begin editing. Fill in all the required boxes (they will be yellow-colored).