Get Texanplus Hmo Authorization Forms 2020-2025

Filling out the Texanplus Hmo Authorization Forms online can streamline the authorization process and ensure timely medical care. This guide provides clear, step-by-step instructions for successfully completing the form and submitting your request.

Follow the steps to complete the Texanplus Hmo Authorization Forms online:

1. Press the ‘Get Form’ button to access the Texanplus Hmo Authorization Forms. This will open the document in an editable format, allowing you to input your information easily.
2. Begin by entering the date in the designated field at the top of the form. This is important for processing your request in an organized manner.
3. Fill in the Authorization Request Form, starting with the IPA/LPO section. Include the appropriate organization details as required.
4. Provide the patient’s personal information, including their name, date of birth, member ID number, phone number, and complete address.
5. Select the referral type by checking the appropriate box for Durable Medical Equipment (DME), Outpatient Therapy, Inpatient Admission, Outpatient Surgery, Home Health, or Office Visit. Specify any additional information as necessary.
6. For the Referring Physician, enter their name, specialty, address, phone number, fax number, and zip code.
7. Complete the Requested Provider/Facility section with the provider's name, address, phone number, fax number, city, and zip code.
8. If referring out-of-network, justify the reason clearly in the specified section.
9. Describe the requested procedure with details, including the CPT code and any additional procedures that may require codes.
10. List the primary diagnosis with the corresponding ICD-9 code, and include any secondary diagnoses with their ICD-9 codes if applicable.
11. If the date of service is after September 30, 2015, provide the primary and secondary diagnosis ICD-10 codes as required.
12. Input the requested procedure date and the date of the last office visit.
13. Review the completed form for accuracy. Make sure all required sections are filled and all information is correct.
14. Once you have finished filling out the form, save the changes. You have the option to download or print the form for your records, or you can share it as needed.

Begin completing your Texanplus Hmo Authorization Forms online today for a smoother authorization process.