Yes! You can use AI to fill out Express Scripts Prior Authorization Form - General Request Form

Users often list the drug name without specifying the exact strength and formulation (e.g., writing 'Lisinopril' instead of 'Lisinopril 10mg tablet'). This ambiguity forces the reviewer to guess or reject the request, as authorization is specific to the dose. To avoid this, always double-check the prescription and include the full drug name, strength, and form (tablet, capsule, etc.) in the 'Please indicate which drug and strength is being requested' field.

Entering a patient's name, date of birth, or ID number that does not exactly match what is on file with their insurance plan is a frequent error. This often happens when using a nickname instead of a legal name or due to a simple typo. A mismatch leads to an immediate failure to find the patient in the system, causing processing delays or rejection. Always verify this information against the patient's insurance card before submission.

The 'Prescriber DEA/NPI' field is explicitly marked as required, yet it is often left blank or filled with an incorrect number. This information is critical for verifying the prescriber's identity and authority, and its absence will lead to an automatic rejection of the form. Before submitting, ensure the correct, active NPI or DEA number is entered. AI-powered tools like Instafill.ai can store and accurately auto-populate this information to prevent such omissions.

The 'Other Medications/Therapies tried' section is the most important part of the form for justifying the request, but it is frequently left blank or filled with vague statements like 'Patient tried other meds.' This provides no basis for the reviewer to approve the non-preferred drug. To ensure approval, provide a detailed history, including the names of failed medications, dosages, duration of therapy, and specific reasons for failure (e.g., 'Metformin 1000mg BID for 3 months, failed to lower A1c below 8.0%; experienced severe GI distress').

An error occurs when the written diagnosis (e.g., 'High Blood Pressure') does not correspond to the entered ICD code (e.g., a code for diabetes). This discrepancy creates confusion and can lead to a denial if the requested medication is not indicated for the condition listed in the code. Always use a current ICD-10 codebook or search tool to verify that the code accurately represents the specific written diagnosis.

Submitting the form without the prescriber's signature or the date of signature is a simple but critical oversight that invalidates the entire request. This often happens in a rush when staff prepares the form for the physician. A missing signature requires the form to be sent back, signed, and resubmitted, significantly delaying the patient's access to medication. Always perform a final check to ensure the signature and date fields are completed.

Since this form is a flat PDF, offices often print and fill it out by hand, leading to illegible entries for names, numbers, and clinical details. If the processor cannot read the information, they cannot process the request, leading to delays or denials. To prevent this, use clear block lettering or, ideally, use a tool like Instafill.ai which can convert non-fillable PDFs into digitally fillable forms, ensuring all text is perfectly legible.

The form asks for an 'Office Contact Name' and 'Phone Number' for follow-up questions. Often, the prescriber's name is repeated here, or a general office number is used without a specific contact person. This makes it difficult for the insurance company to reach the right person (e.g., the medical assistant who handles prior authorizations), delaying the process. Always list the name and direct line or extension of the staff member most familiar with the patient's prior authorization case.

The 'Quantity Requested' and 'days supply' fields must align logically with the drug's standard dosing. For example, requesting a quantity of 30 for a 90-day supply for a once-daily medication is a common mistake that flags the request for review or causes rejection. Carefully calculate the total quantity needed for the specified supply duration based on the prescribing instructions to avoid these data entry errors.

Medical billing and authorizations now universally require ICD-10 codes, but some offices may accidentally reference outdated ICD-9 codes. Submitting an invalid or outdated code will result in an error and rejection of the prior authorization request. It is crucial to ensure that all diagnostic codes are from the current ICD-10-CM classification system. Using form-filling software with updated medical code libraries can help prevent this mistake.