DOWNLOADS AND RESOURCES

How PATHWAY PLUS guides patients and providers through the reimbursement process:

What information you will need to use PATHWAY PLUS:

• Patient’s Name, Date of Birth and Diagnosis
• Patient’s Phone and Address
• Patient’s Insurance information including subscriber’s name and relationship to patient
• Insurance Carrier’s name, phone, Plan ID, group number or copy of the insurance card
• Product Name
• Dosage Information
• Provider’s Name, Phone and Address
• Provider’s NPI and Tax ID
• Name of Contact (at provider’s office)

Prior Authorization Tips

Prior authorization requirements vary among health care plans. We have listed below some of the forms and documents you might need for a health plan to obtain prior authorization. This list does not guarantee prior authorization approval.

• A Statement of Medical Necessity
• The patient’s health plan information or copy of their insurance card (front and back)
• Any supporting documentation including:
  • The health plan’s prior authorization form
  • Relevant patient history and physical findings
  • Chart notes from the healthcare provider
  • Test and lab results
  • Hospital admission/emergency department notes (if applicable)