IVIG Therapy Prior Authorization Request Form

IVIG Therapy Prior Authorization Made Simple

Securing prior authorization for Intravenous Immunoglobulin (IVIG) therapy can be time-consuming and complex. This IVIG Therapy Prior Authorization Request Form helps healthcare providers, immunology practices, and hospital departments submit complete, organized authorization requests to insurance carriers—reducing back-and-forth delays and improving approval rates.

Built for Immunology Practices and Healthcare Providers

Whether you're an immunologist, allergist, hematologist, or infusion center coordinator, this template captures all the clinical data payers typically require: quantitative immunoglobulin levels, infection history, prior treatment response, and supporting documentation. The structured format ensures nothing gets missed, while conditional logic adapts questions based on diagnosis and treatment history.

Faster Approvals with Complete Documentation

Insurance carriers need clear evidence of medical necessity. This form collects baseline IgG, IgA, and IgM levels, documents recurrent infections with frequency and severity, captures vaccine response data, and allows upload of immunologist notes, lab reports, and clinical letters—all in one submission. By providing a complete clinical picture upfront, you reduce the likelihood of denials or requests for additional information.

Automate Your Authorization Workflow

Connect this form to Stepper to automate what happens after submission. Route requests to appropriate reviewers, update patient records in your EHR or practice management system, send status notifications to care teams, and track authorization outcomes—all without manual data entry. For practices managing high volumes of prior auth requests, this workflow automation saves hours every week.

Paperform is a SOC 2 Type II compliant platform trusted by healthcare organizations worldwide. While Paperform itself is not HIPAA compliant, its flexibility, security features, and integration capabilities make it ideal for administrative and non-PHI workflows that support clinical operations. This template is designed for use cases where HIPAA compliance is not required or where organizations have implemented appropriate safeguards.