Accident Questionnaire (insurer-specific) · Health Insurance Plans
Questionnaire sent by an insurer when a claim suggests the injury or illness may have been caused by a third party (auto accident, workplace injury, slip-and-fall, etc.). Determines whether another insurer or liable party should pay.
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Mail to the address on the questionnaire
Fax to the insurer's subrogation or claims department
Complete through insurer's member portal (if available)
Filing Deadline
Typically 30 days from the date of the letter. Claims related to the incident may be held pending your response.
1-3 weeks. The insurer uses your responses to determine if another party's insurance should pay.
If a third party is liable, your insurer may pursue subrogation. Your claims will be processed once liability is determined.
PA Request (insurer-specific) · Health Insurance Plans
Request for approval of surgical procedures, imaging studies, specialist referrals, or other services requiring pre-authorization. Must demonstrate medical necessity.
Pharmacy PA (insurer/PBM-specific) · Health Insurance Plans / PBMs
Request for coverage of formulary drugs requiring PA, non-formulary drugs, or override of step therapy, quantity limits, or other utilization management edits.
Step Therapy Exception · Health Insurance Plans / PBMs
Request to bypass step therapy requirement and proceed directly to a preferred or non-preferred drug. Must document why first-step drugs are not appropriate for the patient.
Tiering Exception · Part D Plans / Commercial Insurers
Request to obtain a non-preferred drug at the lower cost-sharing tier. Prescriber must provide a supporting statement documenting why the lower-tier alternatives are not appropriate.
Specialty PA (insurer-specific) · Health Insurance Plans / Specialty Pharmacies
Prior authorization request for high-cost specialty medications including biologics, gene therapies, and other complex drugs. Requires detailed clinical criteria documentation.
DME PA (insurer-specific) · Health Insurance Plans / Medicare MACs
Request for coverage of wheelchairs, CPAP machines, hospital beds, prosthetics, orthotics, and other durable medical equipment.
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