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Form FA-166 Zolgensma Prior Authorization Request Form - Nevada
What Is Form FA-166?
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 the Form FA-166?A: Form FA-166 is the Zolgensma Prior Authorization Request Form specific to Nevada.
Q: What is Zolgensma?A: Zolgensma is a gene therapy used for the treatment of spinal muscular atrophy (SMA) in children.
Q: What is a Prior Authorization Request Form?A: A Prior Authorization Request Form is a document used to request approval from an insurance company before a specific medication or treatment is covered.
Q: Why is prior authorization necessary?A: Prior authorization is necessary to ensure that the requested medication or treatment meets the insurance company's coverage criteria.
Form Details:
- 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 printable version of Form FA-166 by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Nevada Department of Health and Human Services.
