Get Spa Procedure Authorization Continuation Of Care - Sipadmin 2020-2025

This guide provides a comprehensive approach to completing the SPA Procedure Authorization Continuation of Care form online. By following these detailed steps, you will ensure that your submission is accurate and complete, facilitating efficient communication and care.

Follow the steps to effectively complete the form online.

1. Press the ‘Get Form’ button to access the form and open it in the designated editor.
2. Fill in the authorization details including urgency level by selecting either 'STAT', 'URGENT', or 'ROUTINE'. Each option triggers a different time frame for processing.
3. Enter the member's personal information including their name, date of birth, insurance ID number, and medical record number.
4. Specify the health plan details and gather the clinician information, including the referring clinician's name and specialty.
5. Complete the procedure authorization request section by detailing the diagnosis and including the appropriate ICD-9 codes. List the procedures required along with the corresponding CPT codes.
6. Indicate the location of the services, specifying whether it is an office, outpatient, or inpatient facility, and provide the facility's name.
7. If applicable, add the estimated length of stay and the date of service.
8. Provide a clinical summary to support the request and include the consulting clinician's signature and date.
9. For the continuation of care request, list additional visits required and succinctly describe the necessary diagnoses and procedures.
10. Complete the PCP review section, including their NPI number, fax number, and any comments before obtaining their signature.
11. Finally, after reviewing all entries for accuracy, save changes and choose the appropriate option to download, print, or share the completed form.

Complete your documents online today for streamlined approval and care.