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Form PA22 Fee for Service (Ffs) Prior Authorization Request Form - Drugs Treating Hepatitis C - Rhode Island
What Is Form PA22?
This is a legal form that was released by the Rhode Island Executive Office of Health and Human Services - a government authority operating within Rhode Island. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the Form PA22 Fee for Service (FFS) Prior Authorization Request Form?
A: The Form PA22 Fee for Service (FFS) Prior Authorization Request Form is a document used in Rhode Island to request prior authorization for drugs treating Hepatitis C.
Q: What is the purpose of the form?
A: The purpose of the form is to request authorization for drugs treating Hepatitis C under the Fee for Service (FFS) program in Rhode Island.
Q: Who can use this form?
A: This form can be used by healthcare providers in Rhode Island who are requesting prior authorization for drugs treating Hepatitis C for their patients under the Fee for Service (FFS) program.
Q: What is the fee associated with the form?
A: The form itself does not have a fee associated with it. However, there may be fees associated with the drugs being requested.
Form Details:
- Released on August 1, 2021;
- The latest edition provided by the Rhode Island Executive Office 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 printable version of Form PA22 by clicking the link below or browse more documents and templates provided by the Rhode Island Executive Office of Health and Human Services.
