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Prior authorization
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#	Item
221	PRIOR AUTHORIZATION POLICY Plegridy™ (peginterferon beta-1a injection, subcutaneous Biogen) To initiate a Coverage Review, Call[removed] Add to Reading List Source URL: statehealthplan.state.nc.us Language: English - Date: 2014-11-24 08:41:24 Multiple sclerosis Medicine Immunosuppressants Autoimmune diseases Antivirals Interferon beta-1a Glatiramer acetate Treatment of multiple sclerosis Interferon Immunology Cytokines Immune system
222	2015 Prior Authorization List and Utilization Guidelines Effective: January 1, 2015 CHEMICAL DEPENDENCY/ SUBSTANCE ABUSE Add to Reading List Source URL: chpw.org Language: English - Date: 2014-12-17 17:01:34 Presidency of Lyndon B. Johnson Health Medicine Government Federal assistance in the United States Healthcare reform in the United States Medicare
223	Microsoft Word - NH - Formulary and prior authorization final to website.doc Add to Reading List Source URL: www.wellsense.org Language: English - Date: 2013-12-09 15:40:07 Healthcare reform in the United States Medicine Federal assistance in the United States Medicaid Presidency of Lyndon B. Johnson Formulary Step therapy Pharmaceutical policy Medicare Part D Cost Utilization Measures Health Pharmaceuticals policy Pharmacy
224	PRIOR AUTHORIZATION POLICY Ofev® (nintedanib capsules Boehringer Ingelheim) To initiate a Coverage Review, Call[removed] Add to Reading List Source URL: statehealthplan.state.nc.us Language: English - Date: 2014-11-24 08:41:21 Respiratory system Idiopathic pulmonary fibrosis Pyridines Usual interstitial pneumonia Interstitial lung disease Pirfenidone Pulmonary fibrosis Nintedanib High resolution CT Lung Pulmonology Pneumonia
225	Out-of-State Prior Authorization Overview of South Dakota Medicaid PA requirements 2 Add to Reading List Source URL: dss.sd.gov Language: English - Date: 2014-12-09 13:37:18 Medicaid Medicare Government Health United States Health Insurance Portability and Accountability Act Federal assistance in the United States Healthcare reform in the United States Presidency of Lyndon B. Johnson
226	Cooperative Agreement Authorization Form Form Instructions: This form must be completed and submitted to the Governor’s Office prior to the engaging any of the following entities in the development of a cooperative ag Add to Reading List Source URL: www.maine.gov Language: English - Date: 2015-01-05 13:55:52 Email Governor of Oklahoma Structure Sociology Business Housing cooperative Real estate Cooperative
227	GUIA PARA COMPLETAR LA HOJA DE SOLICITUD DE PRE AUTORIZACION PARA PMD O PRIOR AUTHORIZATION REQUEST (PAR) COVERSHEET, JURISDICTION C Power Mobility Demonstration Request Date (Fecha de Solicitud): Escriba la fecha en la Add to Reading List Source URL: www.cgsmedicare.com Language: Spanish - Date: 2014-12-15 14:01:30
228	Prior Authorization Code List Add to Reading List Source URL: www.premera.com Language: English - Date: 2014-12-22 16:58:09 Plastic surgery Breast reduction Surgery Rhinoplasty Operative report Mastopexy American Medical Association Medicine Breast surgery Cosmetic surgery
229	Vocational Rehabilitation Prior Authorization (February[removed]The prior authorization guidelines will be implemented March 1st. Any service that begins prior to the authorization casenote and PO start date will be consi Add to Reading List Source URL: dwd.wisconsin.gov Language: English - Date: 2014-06-19 09:25:56 Authorization Invoice
230	SPECIAL EDITION June 7, 2013 Prior Authorization: Safety and Cost Management Premera Blue Cross is incorporating Prior Authorization over the course of the next year to ensure our members receive high-quality, cost-effec Add to Reading List Source URL: www.premera.com Language: English - Date: 2014-12-22 16:59:10 Patient Protection and Affordable Care Act Insurance in the United States Health United States Premera Blue Cross Blue Cross Blue Shield Association Medical necessity

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