Form FA-61 Prior Authorization Request - Actemra (Tocilizumab) - Nevada

Form FA-61 Prior Authorization Request - Actemra (Tocilizumab) - Nevada

What Is Form FA-61?

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-61?
A: Form FA-61 is a Prior Authorization Request form.

Q: What is Actemra (Tocilizumab)?
A: Actemra (Tocilizumab) is a medication used to treat certain types of arthritis.

Q: What is the purpose of Form FA-61?
A: The purpose of Form FA-61 is to request prior authorization for Actemra (Tocilizumab) in Nevada.

Q: Why is prior authorization required for Actemra (Tocilizumab)?
A: Prior authorization is required to ensure appropriate use of Actemra (Tocilizumab) and to determine coverage eligibility.

Q: What information is needed to complete Form FA-61?
A: You will need to provide your personal information, healthcare provider information, and relevant medical documentation.

Q: How long does the prior authorization process take?
A: The length of the prior authorization process can vary, but it is typically completed within a few business days.

Q: What happens after submitting Form FA-61?
A: After submitting Form FA-61, it will be reviewed by the Medicaid program to determine if prior authorization for Actemra (Tocilizumab) will be approved.

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Form Details:

  • Released on May 12, 2017;
  • 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 fillable version of Form FA-61 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.

Download Form FA-61 Prior Authorization Request - Actemra (Tocilizumab) - Nevada

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  • Form FA-61 Prior Authorization Request - Actemra (Tocilizumab) - Nevada, Page 1
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