Instructions for Form F-02667 Prior Authorization Drug Attachment for Headache Agents, Preventative Treatment - Wisconsin

Form F-02667 Prior Authorization Drug Attachment for Headache Agents, Preventative Treatment - Wisconsin

This document contains official instructions for Form F-02667 , Prior Authorization Drug Attachment for Headache Agents, Preventative Treatment - a form released and collected by the Wisconsin Department of Health Services. An up-to-date fillable Form F-02667 is available for download through this link.

FAQ

Q: What is Form F-02667?
A: Form F-02667 is the Prior Authorization Drug Attachment for Headache Agents, Preventative Treatment in the state of Wisconsin.

Q: What is the purpose of Form F-02667?
A: The purpose of Form F-02667 is to request prior authorization for headache agents used for preventive treatment in Wisconsin.

Q: Who needs to complete Form F-02667?
A: Healthcare providers who want to prescribe headache agents for preventive treatment in Wisconsin need to complete Form F-02667.

Q: What information is required on Form F-02667?
A: Form F-02667 requires information about the patient, prescribing healthcare provider, the agent being requested, supporting clinical documentation, and any other relevant details.

Q: How do I submit Form F-02667?
A: Form F-02667 can be submitted via fax, mail, or electronically, as per the instructions provided on the form.

Q: Is there a fee to submit Form F-02667?
A: No, there is no fee to submit Form F-02667 for prior authorization of headache agents.

Q: What happens after submitting Form F-02667?
A: After submitting Form F-02667, the request will be reviewed by the insurance provider to determine whether prior authorization for the requested headache agent will be approved.

Q: How long does it take to get a decision after submitting Form F-02667?
A: The timeframe for a decision on the prior authorization request after submitting Form F-02667 can vary and will depend on the insurance provider's review process.