Form FA-74 Prior Authorization Request - Makena (Hydroxyprogesterone Caproate Injection) - Nevada

Form FA-74 Prior Authorization Request - Makena (Hydroxyprogesterone Caproate Injection) - Nevada

What Is Form FA-74?

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-74?
A: Form FA-74 is a Prior Authorization Request form.

Q: What is Prior Authorization?
A: Prior Authorization is a process where healthcare providers must obtain approval from the insurance company before a prescribed medication or treatment can be covered.

Q: What is Makena?
A: Makena is a brand medication that contains Hydroxyprogesterone Caproate Injection.

Q: What is Hydroxyprogesterone Caproate Injection used for?
A: Hydroxyprogesterone Caproate Injection is used to reduce preterm birth risk in women who are pregnant with one baby and have delivered a preterm baby in the past.

Q: Why is the Form FA-74 needed for Makena?
A: The Form FA-74 is needed for Makena to request prior authorization from the insurance company, so that the medication can be covered.

Q: Who needs to complete the Form FA-74?
A: The healthcare provider prescribing Makena needs to complete the Form FA-74.

Q: What should be included in the Form FA-74?
A: The Form FA-74 should include the necessary patient and healthcare provider information, as well as details about the prescription and medical history.

Q: How long does it take to get a prior authorization decision?
A: The time to get a prior authorization decision can vary, but it is usually within a few business days.

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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-74 by clicking the link below or browse more documents and templates provided by the Nevada Department of Health and Human Services.

Download Form FA-74 Prior Authorization Request - Makena (Hydroxyprogesterone Caproate Injection) - Nevada

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