Navigating healthcare requirements can often feel like deciphering an intricate puzzle, especially when it comes to understanding forms like the West Virginia Public Employees Insurance Agency (PEIA) Prior Authorization form. This form, central to the processing of specific healthcare services for individuals covered under the PEIA, mandates detailed documentation for the approval of certain medical treatments or prescription medications. Located at the crux of administrative healthcare, its thorough completion is essential for ensuring that healthcare providers receive authorization to proceed with the prescribed care. With the PEIA Prior Authorization form, healthcare professionals in West Virginia are required to submit comprehensive information, including the dispensing pharmacy's National Association of Boards of Pharmacy (NABP) number, pharmacy name and address, and pertinent patient details, alongside the medical or pharmaceutical services requested. This submission initiates a review process, demanding a careful evaluation of the necessity and appropriateness of the requested service, thereby implicating both the effectiveness of patient care and the operational efficiency of healthcare provision. The detailed requirements encapsulated in this form, from specific codes to provider and patient information, highlight the intricate balance between administrative oversight and the delivery of healthcare services, making it a pivotal piece in the healthcare management puzzle in West Virginia.
| Question | Answer |
|---|---|
| Form Name | Wv Peia Prior Authorization Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Prescriber, wv peia prior authorization form for medications, wv public employees insurance agency pharmacy prior authorization, WVU |
!
PO Box 9511 HSCN, WVU School of Pharmacy
Morgantown, WV 26505
PHONE |
FAX: |
|
!7$ |
|
|
&$$##$"$ |
|
|
$$8$98$989 |
$$:#$"$;% |
$$:$"<$ |
|
|
|
|
|
|
7$##$% |
$ |
|
|
||
|
|
|
""$ #% |
8$9#8/6/9 |
|
|
||
|
||
|
||
|
|
|
|
|
|
&"$
$$
$ ;
$>;
& "$8"(?9
Dispensing Pharmacy NABP Number
Pharmacy Name:
$ ;
$>;
Pharmacy Address (Street) |
(City) |
(State) |
(Zip) |
&? "$ "?7$"7$&
.&+$ $$$$#"$ #?$ $ #$89@
")'$$ $$ $$ "##$ #$? $ "#$ &
) |
|||
A&$ $ $$ $!$$ "$ #$89$ $#$7@
)
8"$$#'$ $ $$$$$ $'$$"$ $$$$9
"#$$$% #$$ $$"#$"$$$ #&
"$$##"$ "$ #!#$$#!&"$$ $##$'
$"#$ $#'#$$$$($ $$"$ #$$$ $#&" !
!#$ $'$"$ ##$$"$"$ #$&