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