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 the Form FA-74?
A: Form FA-74 is a Prior Authorization Request form.
Q: What is Prior Authorization?
A: Prior Authorization is a process where healthcare providers must obtain approval from the insurance company before a prescribed medication or treatment can be covered.
Q: What is Makena?
A: Makena is a brand medication that contains Hydroxyprogesterone Caproate Injection.
Q: What is Hydroxyprogesterone Caproate Injection used for?
A: Hydroxyprogesterone Caproate Injection is used to reduce preterm birth risk in women who are pregnant with one baby and have delivered a preterm baby in the past.
Q: Why is the Form FA-74 needed for Makena?
A: The Form FA-74 is needed for Makena to request prior authorization from the insurance company, so that the medication can be covered.
Q: Who needs to complete the Form FA-74?
A: The healthcare provider prescribing Makena needs to complete the Form FA-74.
Q: What should be included in the Form FA-74?
A: The Form FA-74 should include the necessary patient and healthcare provider information, as well as details about the prescription and medical history.
Q: How long does it take to get a prior authorization decision?
A: The time to get a prior authorization decision can vary, but it is usually within a few business days.
Download a fillable version of Form FA-74 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.