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This version of the form is not currently in use and is provided for reference only. Download this version of
Form DHS-4424-ENG
for the current year.
Form DHS-4424-ENG Drug Prior Authorization Form - Minnesota
What Is Form DHS-4424-ENG?
This is a legal form that was released by the Minnesota Department of Human Services - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DHS-4424-ENG?
A: DHS-4424-ENG is the Drug Prior Authorization Form used in Minnesota.
Q: What is the purpose of DHS-4424-ENG?
A: The purpose of DHS-4424-ENG is to request prior authorization for prescription drugs in Minnesota.
Q: Who uses the DHS-4424-ENG form?
A: The DHS-4424-ENG form is used by healthcare providers in Minnesota who need to request prior authorization for prescription drugs for their patients.
Q: What information is required on the DHS-4424-ENG form?
A: The DHS-4424-ENG form requires information such as patient demographics, drug information, medical justification, and prior authorization criteria.
Q: What is the deadline for submitting the DHS-4424-ENG form?
A: The deadline for submitting the DHS-4424-ENG form depends on the specific prior authorization requirements of the patient's insurance plan.
Q: Is the DHS-4424-ENG form specific to Minnesota?
A: Yes, the DHS-4424-ENG form is specific to Minnesota and is used for requesting prior authorization for prescription drugs in the state.
Q: Are there any fees associated with submitting the DHS-4424-ENG form?
A: There may be fees associated with submitting the DHS-4424-ENG form, depending on the patient's insurance plan and the specific prior authorization requirements.
Form Details:
- Released on March 1, 2015;
- The latest edition provided by the Minnesota Department of 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 DHS-4424-ENG by clicking the link below or browse more documents and templates provided by the Minnesota Department of Human Services.
