Authorization for Outpatient IV Infusions/Therapy

WSI has changed how a provider requests approval for outpatient IV infusions/therapy. Previously, a provider would contact the claims adjuster managing the claim to obtain approval. However, due to the complexity of certain conditions, IV infusion/therapy now follows WSI’s pharmacy prior authorization process.

To request prior authorization for outpatient IV infusions/therapy:

• Complete the Provider's Request for Medication Prior Authorization (M11) form.
• Fax the form with supporting documentation to 888-786-8695.

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