TX HHS Form 1322. Medicaid Fee-For-Service Prior Authorization Reconsideration Request

The TX HHS Form 1322, Medicaid Fee-For-Service Prior Authorization Reconsideration Request, is a crucial document for healthcare providers seeking to overturn a denied prior authorization request. This form helps resolve issues related to medication therapy and ensures that patients receive the necessary treatment.

To complete this form, healthcare professionals must provide essential information about the patient, including their Medicaid ID, name, date of birth, and duration of therapy. The prescribing physician must also confirm the accuracy of the provided information by signing and dating the document. In addition, the form requires a reason for reconsideration, which should be supported by additional chart notes or documentation if necessary.

The TX HHS Form 1322 is typically used when a prior authorization request has been denied and the healthcare provider wishes to appeal the decision. To initiate the reconsideration process, the form must be completed and faxed along with supporting documentation to the Texas Prior Authorization Call Center at 866-617-8864. By using this form, healthcare providers can ensure that their patients receive the necessary treatment in a timely manner.

• The form is used when a prior authorization request has been denied
• Healthcare professionals must provide patient information and reason for reconsideration
• The prescribing physician must confirm the accuracy of the provided information
• The form requires supporting documentation to be faxed along with the completed form