For retail/pharmacy authorization requests, visit the Our Plans page. Then, select your state and line of business. Under Provider Resources, select Documents & Forms. There you will find the Medication Prior Authorization Request Form.
FOR MEDICAL PROFESSIONAL USE ONLY
The New Pre-Service Medical Authorization Form is LIVE! Meridian has created a universal form to improve efficiencies for the authorization process. The form is user friendly, and provides faster decision making and turnaround time. Learn how to submit an authorization by reading or downloading the forms below.
I attest this request is urgent and medically necessary to treat an injury, illness or condition (not life threatening) within 72 hours to avoid complications and unnecessary suffering or severe pain.
Page Last Modified: 5/4/2017 8:51:37 AM