Form FA-164 Hematopoietic / Hematinic Agents Prior Authorization Request Form - Nevada

What Is Form FA-164?

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-164?A: The Form FA-164 is a Hematopoietic/Hematinic Agents Prior Authorization Request Form used in Nevada.

Q: What are hematopoietic/hematinic agents?A: Hematopoietic/hematinic agents are medications that stimulate the production of red blood cells or help treat blood disorders.

Q: What is the purpose of the Form FA-164?A: The purpose of the Form FA-164 is to request prior authorization for the use of hematopoietic/hematinic agents in Nevada.

Q: Who needs to fill out the Form FA-164?A: Healthcare providers or their representatives need to fill out the Form FA-164 to request prior authorization for hematopoietic/hematinic agents.

Q: Are there any specific requirements for filling out the Form FA-164?A: Yes, there are specific requirements for filling out the Form FA-164, including providing the patient's information, medical history, and justification for the requested medication.

Q: How long does the prior authorization process take?A: The length of the prior authorization process can vary, but it typically takes a few days to a couple of weeks.

Q: What happens after the Form FA-164 is submitted?A: After the Form FA-164 is submitted, it will be reviewed by the Nevada Medicaid program to determine if the requested medication meets the necessary criteria for coverage.

Q: Can the Form FA-164 be submitted electronically?A: Yes, the Form FA-164 can be submitted electronically through the Nevada Medicaid portal or by fax.

Q: Is there a fee for submitting the Form FA-164?A: No, there is no fee for submitting the Form FA-164.