Get Long Acting - Tenncare Pharmacy Program - Magellan Health ...

Completing the Long Acting - TennCare Pharmacy Program - Magellan Health form online can streamline the prior authorization process for long-acting narcotics. This guide offers step-by-step instructions to ensure that your submission is complete and accurate.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Enter the member information, including the last name, first name, ID number, and date of birth. Ensure all details are correct and legible to avoid processing delays.
3. Provide prescriber information by filling in the last name, first name, office address, city, state, NPI number, DEA number, phone number, and fax number. Indicate whether the prescriber is a TennCare provider with a Medicaid ID and if they hold a single-patient contract for the member.
4. In the requested long-acting narcotics section, mark whether the request is for a preferred or non-preferred medication. List the specific medication requested, along with its strength, directions, quantity requested, and total daily dose. Be aware of the dosage thresholds and clinical criteria that may apply.
5. Complete the clinical criteria documentation by checking all applicable diagnoses. Answer questions related to the patient's medication history and current treatment regimen. If applicable, provide a proposed tapering schedule for .
6. Fill out the narcotic monitoring information, including whether a written medical treatment plan has been established and any monitoring activities that have been performed.
7. Ensure the prescriber signature is included and dated at the bottom of the form to confirm the accuracy of the information provided.
8. Once all fields are completed, review your entries for accuracy. Save changes if necessary and proceed to download, print, or share the form as required.

Complete your documents online for a smoother prior authorization experience.