[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288976-105":53,"doc-detail-288976-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","kpic-prior-authorization-request-form-instructionsprocess","KPIC Prior Authorization Request Form - Instructions/Process","","KPIC’s Uniform Pharmacy prior authorization request instructions explain how to obtain coverage approval for certain outpatient prescription drugs requiring Medical Necessity review. The process directs prescribers to identify eligible drugs in the Drug Formulary, complete and submit the KPIC Uniform Pharmacy Prior Authorization Request Form to MedImpact by fax, mail, or electronically, and to include required supporting clinical rationale and patient/provider details. Processing timelines differ for urgent vs. non-urgent requests, and approvals remain valid for at least 180 days.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/kpic-prior-authorization-request-form-instructionsprocess/288976/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/kpic-prior-authorization-request-form-instructionsprocess/288976.png","ImageObject",442,249,{"name":88,"@type":89},"Dozel","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-07","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"Where can I find the list of drugs that require prior authorization?","Question",{"text":109,"@type":110},"Visit http://kp.org/kpic-colorado and check the “Drug Formulary” section for an alphabetical list of drugs requiring prior authorization.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How does MedImpact process urgent versus non-urgent prior authorization requests?",{"text":114,"@type":110},"Urgent requests require MedImpact to approve, deny, or request additional information within 1 business day, while non-urgent requests allow 3 business days. If more information is requested, timelines for both types are also specified in the instructions.",{"name":116,"@type":107,"acceptedAnswer":117},"How long is an approved prior authorization valid?",{"text":118,"@type":110},"Once approved, the prior authorization approval is valid for a minimum of 180 days from the date of approval, and the actual duration is determined by clinical criteria and stated in the approval letter.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288976,1790362288,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},962085662650,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","KPIC Prior Authorization Request Form – Instructions/Process  \nWhen an outpatient prescription drug requiring Prior Authorization has been prescribed, please follow the instructions below:  \n1. Please visit [http://kp.org/kpic-colorado](http://kp.org/kpic-colorado) particularly the “Drug Formulary” section for an alphabetical list of drugs, including both brand name and scientific name, that require prior authorization.  \n2. Your Prescribing Provider must complete and submit to MedImpact utilization management program KPIC’s Uniform Pharmacy Prior Authorization Request Form which is available below.  \n3. You or Your Prescribing Provider can also request a copy of KPIC’s Uniform Prior Authorization Request Form from MedImpact by calling 1-800-788-2949 (Pharmacy Help Desk) or 711 (TTY), 24 hours a day, 7 days a week.  \n4. KPIC’s Uniform Pharmacy Prior Authorization Request Form can be sent to MedImpact via fax at 1- 858-790-7100 or via mail to the following address:  \nMedImpact  \n10181 Scripps Gateway Court  \nSan Diego, CA 92131  \nNOTE: Prior authorization requests contained on a form other than KPIC’s Uniform Pharmacy Prior Authorization Request Form or state mandated form will be rejected.  \n5. Your provider can also submit prior authorization requests electronically. Visit [https://www.medimpact.com/Prior-Authorization-Forms](https://www.medimpact.com/Prior-Authorization-Forms) for more information on how to submit requests electronically.  \n6. Below are the required timelines for the processing of prior authorization requests computed from the date of receipt:  \n\n| Type of Request | Days MedImpact* has to approve, deny or request additional information | Days Prescriber** has to provide additional information if requested | Days MedImpact* has to approve or deny once additional information is received |\n| --- | --- | --- | --- |\n| Urgent | 1 Business Day | 2 Business Days | 1 Business Day |\n| Non Urgent | 3 Business Days | 2 Business Days | 2 Business Days |\n\n*If MedImpact does not meet the required timeline, the request for prior authorization will be deemed approved.  \n**If the Prescribing provider does not meet the required timeline, the request for prior authorization will be deemed denied.  \n7. Once approved, a prior authorization approval is valid for a minimum of one hundred eighty (180) days after the date of approval. The actual approval duration will be based on clinical criteria and identified in the Prior Authorization approval letter.  \n8. Upon the expiration of the validity period of one hundred eighty (180) days,(or longer as identified in the Prior Authorization approval letter), your Prescribing Provider will be required to complete and submit anew KPIC’s Uniform Pharmacy Prior Authorization Request Form.  \n9. Clinical Criteria and supporting references that should be considered within the rationale in making a prior authorization determination are:  \no Height/Weight  \no Compound ingredients  \no Specific dosage form consideration  \no Drug or Other Related Allergies  \nPlease consider providing the following information as applicable & when available:  \no Healthcare Common Procedure Coding System (HCPCS)  \no Transition of Care Hospital and/or Residential Treatment Facilities Information (contact, phone number, length of stay)  \no Life Situations Information such asfoster care transition, homelessness, poly-substance abuse and history of poor medication adherence  \no Patient information (address, phone number)  \no Provider information (direct electronic contact information: e-mail, etc.)  \nHelpful Definitions  \nPrior Authorization: certain covered outpatient prescription drugs will require an approval where the prescribed medication will be reviewed by Us to determine Medical Necessity before the prescription is filled. This approval process is called the prior authorization process.  \nUrgent Prior Authorization Request: a request for prior authorization when based on the reasonable opinion of the Prescribing P","cbCaiuuAKTVDh6Fc","https://ap.wps.com/l/cbCaiuuAKTVDh6Fc","pdf",342395,"English","# Instructions/Process\n## Submission methods\n## Processing timelines\n## Approval validity and resubmission\n## Clinical criteria and supporting information\n## Helpful definitions","[{\"question\":\"Where can I find the list of drugs that require prior authorization?\",\"answer\":\"Visit http://kp.org/kpic-colorado and check the “Drug Formulary” section for an alphabetical list of drugs requiring prior authorization.\"},{\"question\":\"How does MedImpact process urgent versus non-urgent prior authorization requests?\",\"answer\":\"Urgent requests require MedImpact to approve, deny, or request additional information within 1 business day, while non-urgent requests allow 3 business days. If more information is requested, timelines for both types are also specified in the instructions.\"},{\"question\":\"How long is an approved prior authorization valid?\",\"answer\":\"Once approved, the prior authorization approval is valid for a minimum of 180 days from the date of approval, and the actual duration is determined by clinical criteria and stated in the approval letter.\"}]","KPIC Prior Authorization Request Form - Instructions/Process | PDF",1789634325]