Prior Auth Required

13047 - (07/12)) form

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / Service(07/12)) form
Procedure / Service Description

Wisconsin Medicaid - ❍ Claims submitted to Timely Filing appeals must be submitted on paper with a Timely Filing Appeals Request (F- 13047 (07/12)) form. ❍ In certain circumstances, drug claims must be submitted on paper with a Pharmacy Special Handling Request (F-

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.