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This means that you will need to get approval from Virginia Premier Gold before you fill your prescriptions for some drugs. If you don't get approval, Virginia Premier Gold may not cover the drug. You can find out which drugs require prior authorization by reviewing the Virginia Premier Gold Formulary. Usually, your doctor will have to give us information about your medical condition or previous prescriptions in order to receive prior authorization.
Generally, we must make our decision within 72 hours of getting you or your prescribing physician's request for standard coverage determinations or 24 hours of getting you or your prescribing physician's request for an expedited coverage determination.
Members wishing to request a prior authorization or check on the status of a prior authorization request submitted by their doctor should contact our Member Services Department 8:00 a.m. to 8:00 p.m., seven days a week:
| Telephone: |
1-866-616-1041 |
| TTY/TDD: |
1-800-828-1120/1140 |
Click here to download the Enrollees Coverage Determination Request Form. Mail or fax the completed form to:
Virginia Premier Gold
Prior Authorization Department
200 Stevens Drive
Philadelphia, PA 19113
Fax Standard: 866-880-3679
Fax Urgent: 866-879-6668
Click here for the Appointment of Representative Form and for more information on how to appoint a representative.
Providers who would like to submit a prior authorization request may either contact our Provider Help Desk at 1-888-765-9583, or use our physician's coverage determination form available below. Please answer all questions on the form and fax to the phone number listed on the form.
Click here for the Physician's Coverage Determination Request Form. Fax or mail the completed form to:
Virginia Premier Gold
Prior Authorization Department
200 Stevens Drive
Philadelphia, PA 19113
Fax Standard: 866-880-3679
Fax Urgent: 866-879-6668
What can I do if my Coverage Determination is denied?
If Virginia Premier Gold denies your coverage determination you have the right to request a redetermination appeal. Please see our section on Appeals and Grievances for information about your appeal rights, or contact our Member Services Department 8:00 a.m. - 8:00 p.m., seven days a week.
| Telephone: |
1-866-616-1041 |
| TTY/TDD: |
1-800-828-1120/1140 |
Click here for more information on Appeals & Grievances.
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