|
This means that you will need to get approval from Virginia Premier Gold before the member fills their 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, you will have to give us information about the member's medical condition or previous prescriptions in order to receive prior authorization.
Generally, we will give you and the member our decision within 72 hours of getting your request for standard coverage determinations or 24 hours of getting your request for an expedited coverage determination.
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 be done if a Coverage Determination is denied?
If Virginia Premier Gold denies the coverage determination the member or their representative has the right to request a redetermination appeal. Physicians have the right to request an expedited redetermination appeal on a member's behalf. Please see our section on Appeals and Grievances for information about member 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.
|