Form FA-65 Synagis Prior Authorization - Nevada

What Is Form FA-65?

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-65 Synagis?
A: Form FA-65 is a prior authorization form for Synagis.

Q: What is Synagis?
A: Synagis is a medication used to prevent respiratory syncytial virus (RSV) infection in certain high-risk infants.

Q: Who needs to complete Form FA-65?
A: Healthcare providers need to complete Form FA-65 for their patients who require Synagis treatment.

Q: What is the purpose of Form FA-65?
A: The purpose of Form FA-65 is to request prior authorization from the Nevada Medicaid program for Synagis.

Q: What information is required on Form FA-65?
A: Form FA-65 requires information about the patient, healthcare provider, and medical necessity for Synagis treatment.

Q: How long does it take to get prior authorization for Synagis?
A: The processing time for a prior authorization request may vary, but it is typically within a few business days.

Q: Is Synagis covered by Nevada Medicaid?
A: Yes, Synagis is covered by Nevada Medicaid, but prior authorization is required.

Q: Are there any specific eligibility criteria for Synagis treatment?
A: Yes, there are specific eligibility criteria for Synagis treatment, including age, medical condition, and risk factors.

Q: Can Form FA-65 be submitted electronically?
A: Yes, Form FA-65 can be submitted electronically through the Nevada Medicaid Provider Portal.