Prior Auth Required

11034 - for physician-administered drugs, the Portal will prompt a PA/JCA (Prior Authorization/"J" Code Attachment, F- (07/12))

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Servicefor physician-administered drugs, the Portal will prompt a PA/JCA (Prior Authorization/"J" Code Attachment, F- (07/12))
Procedure / Service Description

Wisconsin Medicaid - Almost all PA request attachments can be completed and submitted on the Portal. When providers are completing PA requests, the Portal presents the necessary attachments needed for that PA request. For example, if a physician is completing a PA request for physician-administered drugs, the Portal will prompt a PA/JCA (Prior Authorization/"J" Code Attachment, F-11034 (07/12)) and display the form for the provider to complete. Certain PA attachments cannot be completed online or uploaded.

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.