Prior Auth Required

11183 - Program Designation of Alternate Prescriber for Restricted Medication Services (F- (12/10)) form and return it to the

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / ServiceProgram Designation of Alternate Prescriber for Restricted Medication Services (F- (12/10)) form and return it to the
Procedure / Service Description

alternate prescriber to prescribe restricted medications, the primary prescriber should complete the Pharmacy Services Lock-In - medications using his or her professional discretion, and designates an alternate prescriber if needed. If the member requires an alternate prescriber to prescribe restricted medications, the primary prescriber should complete the Pharmacy Services Lock-In Program Designation of Alternate Prescriber for Restricted Medication Services (F-11183 (12/10)) form and return it to the Pharmacy Services Lock-In Program and to the member's HMO, if applicable.

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.