5 Ways To Complete The Az&Me Provider Form

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As a healthcare provider, completing the Az&Me provider form is an essential step in getting enrolled in the Az&Me program, which offers discounts on Eli Lilly and Company medications for eligible patients. However, filling out the form can be a daunting task, especially for those who are new to the program. In this article, we will guide you through the process of completing the Az&Me provider form, highlighting five key steps to ensure accurate and efficient completion.

Understanding the Az&Me Provider Form

Before we dive into the completion process, it's essential to understand the purpose of the Az&Me provider form. The form is used to collect information about your medical practice, patient demographics, and prescription writing habits. This information helps Eli Lilly and Company to determine eligibility for the Az&Me program and ensures that patients receive the discounts they need.

Step 1: Gather Required Information

To complete the Az&Me provider form, you will need to gather specific information about your medical practice. This includes:

• Your name and title
• Medical practice name and address
• Contact information (phone number and email)
• National Provider Identifier (NPI) number
• State medical license number
• DEA number (if applicable)

Having this information readily available will make it easier to complete the form accurately and efficiently.

Step 2: Determine Patient Eligibility

Patient Eligibility Criteria

To enroll patients in the Az&Me program, you need to determine their eligibility. The program is designed for patients who have been prescribed Eli Lilly and Company medications and meet specific income and insurance requirements. The eligibility criteria include:

• Patients must be residents of the United States or Puerto Rico
• Patients must have a valid prescription for an Eli Lilly and Company medication
• Patients must meet income guidelines (varies by state)
• Patients must have no prescription coverage or have coverage with a high deductible

By understanding the eligibility criteria, you can identify patients who may benefit from the Az&Me program and complete the form accordingly.

Step 3: Complete the Form Accurately

Avoiding Common Errors

When completing the Az&Me provider form, it's essential to avoid common errors that can delay processing or result in rejection. These errors include:

• Incomplete or missing information
• Incorrect NPI or state medical license number
• Failure to sign and date the form

To avoid these errors, take your time when completing the form, and ensure that all required fields are filled in accurately. If you're unsure about any information, don't hesitate to contact Az&Me customer support for assistance.

Step 4: Submit the Form

Once you've completed the Az&Me provider form, submit it to Eli Lilly and Company via fax or mail. Ensure that you keep a copy of the completed form for your records.

Step 5: Verify Patient Enrollment

Confirming Patient Enrollment

After submitting the Az&Me provider form, verify that your patients have been successfully enrolled in the program. You can do this by:

• Checking the Az&Me website for patient enrollment status
• Contacting Az&Me customer support for assistance
• Reviewing patient eligibility and enrollment confirmation letters

By verifying patient enrollment, you can ensure that your patients receive the discounts they need and that you're providing the best possible care.

Tips for Efficient Completion

• Use the Az&Me provider form template to ensure accurate completion
• Keep a copy of the completed form for your records
• Submit the form via fax or mail to expedite processing
• Verify patient enrollment to ensure successful program participation

Conclusion

Completing the Az&Me provider form is a straightforward process that requires attention to detail and accurate information. By following the five steps outlined in this article, you can ensure efficient and accurate completion of the form. Remember to gather required information, determine patient eligibility, complete the form accurately, submit the form, and verify patient enrollment. By doing so, you can provide your patients with the discounts they need and improve their overall healthcare experience.

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