[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288617-105":53,"doc-detail-288617-en":126},{"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":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","pharmacy-prior-authorization-process","Pharmacy Prior Authorization Process","","Pharmacy Prior Authorization Process explains why certain medications require insurer approval before coverage. It outlines how prescribers initiate non-urgent and urgent prior authorization requests through forms submitted to Navitus via mail, web, fax, or phone, including criteria for urgent review. The document describes submission details and contact channels, what occurs when information is missing or criteria are unmet, and how approvals are granted for a defined time. It also states how members and providers receive written notification, and where to obtain further guidance.",{"@graph":63,"@context":118},[64,80,101],{"@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":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/pharmacy-prior-authorization-process/288617/",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/pharmacy-prior-authorization-process/288617.png","ImageObject",442,249,{"name":88,"@type":89},"Violet","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-21","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":9},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is a prior authorization in pharmacy coverage?","Question",{"text":108,"@type":109},"A prior authorization is when a prescriber must receive approval from the health insurance plan to cover a medication. Certain medications require this approval before coverage applies.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How can a prescriber start a non-urgent prior authorization request?",{"text":113,"@type":109},"A prescriber can submit a prior authorization form to Navitus via U.S. Mail, web submission, fax, or by contacting the Navitus call center to speak with a Prior Authorization Specialist.",{"name":115,"@type":106,"acceptedAnswer":116},"What happens if the submitted prior authorization information is incomplete or does not meet coverage criteria?",{"text":117,"@type":109},"If the form lacks needed information, the prescriber is contacted and must respond within a designated time frame or the request is denied. If criteria are not met, the request is denied and appeal rights are provided.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},288617,1790020394,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":76,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},4398048950312,"https://ap-avatar.wpscdn.com/avatar/400002538284de19e3c?_k=1778320343897328908","Pharmacy Prior Authorization Process  \nCertain medications require prior authorization. Please review your formulary for coverage information. A Prior Authorization is when your prescriber has to receive approval from your health insurance plan to cover a medication.  \nHow does my prescriber begin the Prior Authorization process?  \nNon-Urgent Requests  \nA prescriber can submit a Prior Authorization Form to Navitus via U.S. Mail, web submission, fax, or they can contact the Navitus call center to speak to a Prior Authorization Specialist. The request processes as quickly as possible once all required information is together.  \nUrgent Requests  \nA prescriber may notify Navitus by phone or fax of an urgent request submission.  \nPrescribers may request an urgent review for a patient who is hospitalized, a patient with a life-threatening condition, or to authorize treatment of an acute illness or injury. Prescribers should submit an urgent request if the patient’s health could be seriously jeopardized without the medication. The member and prescriber are notified as soon asthe decision has been made.  \nHow does my prescriber submit a completed Prior Authorization form to Navitus?  \nMode  \nContact Information  \nU.S. Mail  \nFax  \nPhone  \nNavitus Health Solutions LLCAttn: Prior Authorizations 1025 West Navitus Drive Appleton, WI 54913  \n1.855.668.8551 (toll free) -Commercial 1.855.668.8552 (toll free) -Medicare  \n1.855.668.8553 (toll free) -Medicaid  \n1.866.333.2757  \nAny time a PA is required and either the provider is not available to submit the PA request, or Navitus is not going to meet the turnaround requirement, Federal and Texas law requires pharmacies to dispense a 72-hour supply as long as the member will not be harmed if the PA is denied and therapy will be discontinued.  \nWhat happens after my prescriber submits the request?  \nIf the submitted form does not have all of the needed information, the prescriber will be contacted to provide the information. If the prescriber does not respond within a designated time frame, the request will be denied.  \nIf the submitted information does not meet the criteria for coverage of the medication, the request will be denied and appeal rights will be provided.  \nIf the submitted information meets the criteria for coverage of the medication, the request will be approved for a determined amount of time.  \nHow will I find out if my Prior Authorization request is approved or denied?  \nThe member and provider will be notified in writing of the decision.  \nHow can I get more information about a Prior Authorization?  \nPlease contact Pharmacy Customer Care toll-free at the number listed on your Sendero member ID card.","cbCaif9v8BRTh2Uz","https://ap.wps.com/l/cbCaif9v8BRTh2Uz","pdf",230903,"English","# Prior Authorization Basics\n## Non-Urgent Requests\n## Urgent Requests\n# Submitting a Completed Form\n## Submission Modes and Contact Information\n## Pharmacy Dispensing During Turnaround Constraints\n# After the Request Is Submitted\n## Missing Information\n## Denial Reasons and Appeal Rights\n## Approval Duration\n# Decision Notification and Further Information","[{\"question\":\"What is a prior authorization in pharmacy coverage?\",\"answer\":\"A prior authorization is when a prescriber must receive approval from the health insurance plan to cover a medication. Certain medications require this approval before coverage applies.\"},{\"question\":\"How can a prescriber start a non-urgent prior authorization request?\",\"answer\":\"A prescriber can submit a prior authorization form to Navitus via U.S. Mail, web submission, fax, or by contacting the Navitus call center to speak with a Prior Authorization Specialist.\"},{\"question\":\"What happens if the submitted prior authorization information is incomplete or does not meet coverage criteria?\",\"answer\":\"If the form lacks needed information, the prescriber is contacted and must respond within a designated time frame or the request is denied. If criteria are not met, the request is denied and appeal rights are provided.\"}]","Pharmacy Prior Authorization Process | PDF",1789633706]