Get Adnic Pre Authorization 2020-2026

Filling out the Adnic Pre Authorization form is an important step in ensuring that medical services are covered appropriately. This guide provides clear, step-by-step instructions to help users complete the form correctly and efficiently.

Follow the steps to complete your pre-authorization request online.

1. Press the ‘Get Form’ button to access the Adnic Pre Authorization form and open it in your preferred editor.
2. Enter the provider's name in the designated field. Make sure to provide accurate information to avoid processing delays.
3. Fill in the provider code, which is essential for identification purposes.
4. Input the ADNIC card number as it is critical for verifying the member's identity and eligibility.
5. Enter the date of birth of the member accurately to avoid any issues with the request.
6. Provide a mandatory mobile number, as it may be necessary for further communication regarding the request.
7. Select whether the request is for in-patient or out-patient services by checking the appropriate box.
8. List the primary diagnoses using ICD-9 codes, and indicate if the visit is for an emergency room, work-related injury, or road traffic accident.
9. Provide details for secondary diagnoses if applicable, following the same format as the primary diagnoses.
10. In the 'Description & Detailed Medical History' section, describe the patient’s condition and medical history relevant to the request.
11. Input the associated charge codes or descriptions in the relevant fields as accurately as possible.
12. Detail the procedures to be performed, including room/day case charges, consumables, radiology, pharmaceuticals, and laboratory costs.
13. Calculate the total amount to ensure all costs are captured and reflected accurately.
14. Indicate the number of documents attached that support the request.
15. Ensure the form is signed by the doctor or stamped as required for validation.
16. Submit your request by faxing it to the number 02-4080642. For any queries, call the provided toll-free number 8008040.
17. Finally, sign the member signature field to confirm that the information provided is accurate and complete.

Complete your Adnic Pre Authorization request online for a smoother and more efficient process.