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Form PA-103 Synagis / Respigam Prior Authorization - South Dakota
What Is Form PA-103?
This is a legal form that was released by the South Dakota Department of Social Services - a government authority operating within South Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form PA-103?A: Form PA-103 is a prior authorization form for Synagis/Respigam.
Q: What is Synagis?A: Synagis is a medication used to prevent a serious lung infection called respiratory syncytial virus (RSV) in high-risk infants and children.
Q: What is Respigam?A: Respigam is a medication used to prevent a serious lung infection called respiratory syncytial virus (RSV) in high-risk infants and children.
Q: What is a prior authorization?A: A prior authorization is a process where healthcare providers must receive approval from the insurer before certain medications or treatments can be covered.
Q: Who needs to complete Form PA-103?A: Healthcare providers in South Dakota who want to prescribe Synagis or Respigam need to complete Form PA-103 for prior authorization.
Q: Are there any specific requirements for completing Form PA-103?A: Yes, healthcare providers need to provide detailed clinical information to support the need for Synagis or Respigam and indicate the patient's high-risk status.
Q: What happens after submitting Form PA-103?A: After submitting the form, the insurer will review the information provided and determine if Synagis or Respigam will be covered.
Q: Is there a deadline for submitting Form PA-103?A: The specific deadline for submitting Form PA-103 may vary, so it is important to check with your insurer or healthcare provider for the timeline.
Q: Can Form PA-103 be used for other medications?A: No, Form PA-103 is specifically for Synagis and Respigam prior authorization in South Dakota.
Form Details:
- Released on December 1, 2022;
- The latest edition provided by the South Dakota Department of Social 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 fillable version of Form PA-103 by clicking the link below or browse more documents and templates provided by the South Dakota Department of Social Services.
