Form FA-67 Prior Authorization Request - Growth Hormone for Recipients Under Age 21 - Nevada

Form FA-67 Prior Authorization Request - Growth Hormone for Recipients Under Age 21 - Nevada

What Is Form FA-67?

This is a legal form that was released by the Nevada Department of Health and Human Services - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FA-67?A: Form FA-67 is a Prior Authorization Request for Growth Hormone for recipients under the age of 21 in Nevada.

Q: Why is prior authorization required for Growth Hormone?A: Prior authorization is required to ensure that Growth Hormone is medically necessary and appropriate for recipients under the age of 21.

Q: Who needs to fill out Form FA-67?A: The healthcare provider responsible for the recipient's care needs to fill out Form FA-67.

Q: What information is needed to fill out Form FA-67?A: The healthcare provider will need to provide information about the recipient's medical condition, treatment plan, and any previous treatments.

Q: How long does it take to process a prior authorization request?A: The processing time for a prior authorization request can vary, but it is typically within a few business days.

Q: What happens after Form FA-67 is submitted?A: After Form FA-67 is submitted, it will be reviewed by the Medicaid program to determine if the request meets the necessary criteria for approval.

Q: What should I do if Form FA-67 is denied?A: If Form FA-67 is denied, the healthcare provider can appeal the decision or explore alternative treatment options.

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Form Details:

  • Released on July 28, 2017;
  • The latest edition provided by the Nevada Department of Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FA-67 by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Nevada Department of Health and Human Services.

Download Form FA-67 Prior Authorization Request - Growth Hormone for Recipients Under Age 21 - Nevada

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