Washington Direct-Acting Antiviral for Hepatitis C Prior Authorization Form

• Category: Washington Workers Compensation - Official
• State: Washington
• Control #: WA-SKU-3523
• Format: PDF

Description

Direct-Acting Antiviral for Hepatitis C Prior Authorization Form Washington Direct-Acting Antiviral for Hepatitis C Prior Authorization Form is a form used by the Washington State Health Care Authority to determine if a patient's health plan will cover the cost of certain Direct Acting Antiviral (DAA) medications for the treatment of Hepatitis C. The form is used to assess the medical necessity of the requested treatment and the patient's eligibility for coverage. The form includes information on the patient's medical history, current medications, laboratory tests, and other pertinent information. It also requires the patient's signature before submission. There are two types of Washington Direct-Acting Antiviral for Hepatitis C Prior Authorization Forms: Standard and Express. The Standard form is used for the initial review of the patient's request and requires additional information and documentation from the patient's doctor. The Express form is used for subsequent requests and requires less information and documentation.

Washington Direct-Acting Antiviral for Hepatitis C Prior Authorization Form is a form used by the Washington State Health Care Authority to determine if a patient's health plan will cover the cost of certain Direct Acting Antiviral (DAA) medications for the treatment of Hepatitis C. The form is used to assess the medical necessity of the requested treatment and the patient's eligibility for coverage. The form includes information on the patient's medical history, current medications, laboratory tests, and other pertinent information. It also requires the patient's signature before submission. There are two types of Washington Direct-Acting Antiviral for Hepatitis C Prior Authorization Forms: Standard and Express. The Standard form is used for the initial review of the patient's request and requires additional information and documentation from the patient's doctor. The Express form is used for subsequent requests and requires less information and documentation.