Prior Auth Required

10637 - Topic #

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceTopic #
Procedure / Service Description

When a PA requirement is added to the list of drugs requiring PA and the effective date of a PA falls in the middle of a billing - period, two separate claims that coincide with the presence of PA for the drug must be submitted to ForwardHealth. Topic #10637

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.