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Form FA-199 Entresto (Sacubitril-Valsartan) Prior Authorization Request Form - Nevada
What Is Form FA-199?
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-199?A: Form FA-199 is the Prior Authorization Request Form for Entresto (Sacubitril-Valsartan) in Nevada.
Q: What is Entresto?A: Entresto is a medication that contains a combination of sacubitril and valsartan. It is used to treat heart failure.
Q: What is sacubitril?A: Sacubitril is a neprilysin inhibitor that helps to increase the levels of certain substances that dilate blood vessels and reduce sodium and fluid retention.
Q: What is valsartan?A: Valsartan is an angiotensin receptor blocker (ARB) that helps to relax blood vessels and lower blood pressure.
Q: Who needs to fill out Form FA-199?A: Form FA-199 needs to be filled out by healthcare providers in Nevada who are requesting prior authorization for Entresto.
Q: What is the purpose of Form FA-199?A: The purpose of Form FA-199 is to request prior authorization for the use of Entresto in Nevada.
Q: What information is needed on Form FA-199?A: Form FA-199 requires information about the patient, healthcare provider, medical history, and justification for the use of Entresto.
Q: How long does it take to get a response for Form FA-199?A: The response time for Form FA-199 can vary, but typically it takes a few days to a couple of weeks.
Form Details:
- Released on March 31, 2022;
- 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-199 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.
