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Still missing
- Full legal name as it appears on the insurance card
- Date of birth
- Full address including ZIP
- Best phone number
- Email where the hub can reach them
- Medical insurance — carrier, member ID, group
- Pharmacy benefit — BIN, PCN, group, from the Rx card
- Secondary or tertiary coverage where it exists
- Prescriber name and credential
- NPI
- Practice name and address
- Office phone and fax
and 17 more
Where it goes
- Form
- Skyrizi Enrollment Form, or enroll on CompletePro
- Enrollment fax
- 1-678-727-0690
- Signature
- not required
- BV back in
- Benefits verification should reach the office within 1 business day
- Hub
- Skyrizi Complete
866-759-7494 - PAP fax
- 866-250-2803
- Pharmacy
- Pharmacy Solutions (AbbVie)
- Note
- Complete Pro back-up fax 678-727-0494.
Handoff note
ENROLLMENT FORM CHECK — Skyrizi Completeness: 0% (0 of 29 generic fields) Routing: not set Form: Skyrizi Enrollment Form, or enroll on CompletePro Fax to: 1-678-727-0690 Patient signature: NOT required SEND WITH IT: [ ] Face / demographic sheet [ ] Insurance card, both sides, medical and pharmacy [ ] The product's enrollment form [ ] Lab results [ ] Minimum 2 visit notes - the last note and one showing worse BSA OUTSTANDING: [ ] Full legal name as it appears on the insurance card [ ] Date of birth [ ] Full address including ZIP [ ] Best phone number [ ] Email where the hub can reach them [ ] Medical insurance — carrier, member ID, group [ ] Pharmacy benefit — BIN, PCN, group, from the Rx card [ ] Secondary or tertiary coverage where it exists [ ] Prescriber name and credential [ ] NPI [ ] Practice name and address [ ] Office phone and fax [ ] Office contact for the hub to call [ ] Diagnosis with ICD-10 code [ ] Drug, strength and directions [ ] Quantity and refills [ ] Prior therapies tried and failed [ ] Relevant lab results where the form asks [ ] Patient signature << high consequence [ ] Patient signature date << high consequence [ ] Prescriber signature << high consequence [ ] Prescriber signature date << high consequence [ ] HIPAA authorization signed where the form carries one << high consequence [ ] Benefits investigation requested << high consequence [ ] Prior authorization support requested << high consequence [ ] Appeal support requested << high consequence [ ] Copay program enrollment requested << high consequence [ ] Bridge or free-trial program requested where applicable << high consequence [ ] Nurse or injection-training support requested << high consequence Generic field classes only — not this product's actual form. Fax numbers and signature rules are transcribed from the reference binder and UNVERIFIED. No patient information recorded in this tool.
Why this existsEnrollment Forms 101 in the source material is emphatic that an incomplete form is a leading cause of delay, and that a form goes back and forth rather than being processed. The fix is checking before it is sent, not after.
Patient information
0 / 5A mismatch against the insurance card is an automatic kickback.
Insurance
0 / 3The pharmacy identifiers are the ones most often left blank, and they are the ones that decide where the script can be filled.
Prescriber
0 / 5A mid-level's NPI on a specialist-restricted product denies automatically.
Clinical
0 / 5The diagnosis code has to match an indication the plan accepts.
Signatures and dates
0 / 5The single most common reason a form comes back. An unsigned or undated form is not a form.
This product needs no patient signatureA third-party coordinator binder is explicit that Skyrizi does not require a patient signature on the enrollment form (Skyrizi Enrollment Form, or enroll on CompletePro). Don't hold the form waiting for one. Binder p.150 — unverified.
From the source binderNO patient signature needed.
From the source binderShares its fax with Rinvoq -- both AbbVie.
Services requested — the boxes
0 / 6If the boxes are not ticked, those services are not provided. This is the field class coordinators miss most often and the one with the largest consequence — the hub simply does not do the work nobody asked for.
The boxes are not optionalIf a service box is not ticked, the hub does not perform that service. No benefits investigation, no PA support, no appeal help — not because they refused, but because nobody asked. This is the field class with the largest gap between effort and consequence.
Where is this form going?
What this does not knowThese are the field classes that appear on essentially every manufacturer enrollment form. It is not this product's actual form. Per-form required-field lists need the real PDFs, which we do not hold — so treat a 100% score as "nothing obvious is missing", not as "this form is complete".