PROMPT
Rx Prompt Pa Form. If you have 10 or. Service code if available (hcpcs/cpt) new prior authorization.
Up to 10 drugs with different dates of fill can be requested at one time. Service code if available (hcpcs/cpt) new prior authorization. Web for direct member reimbursement: Web start date of service. This can be located on your medical id card (if you have a combined medical and pharmacy card), on your. If you have 10 or.
This can be located on your medical id card (if you have a combined medical and pharmacy card), on your. This can be located on your medical id card (if you have a combined medical and pharmacy card), on your. If you have 10 or. Up to 10 drugs with different dates of fill can be requested at one time. Service code if available (hcpcs/cpt) new prior authorization. Web for direct member reimbursement: Web start date of service.
