Get Pehp Health & Benefits Prior Authorization For Anesthesia Services For Dental Procedures Under 2016
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How to fill out the PEHP Health & Benefits Prior Authorization For Anesthesia Services For Dental Procedures Under online
Filling out the PEHP Health & Benefits Prior Authorization for Anesthesia Services for Dental Procedures can be straightforward when you have the right guidance. This comprehensive guide will help you complete the form accurately and efficiently, ensuring that all necessary information is provided.
Follow the steps to complete the form accurately.
- Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
- In Section I, enter the patient information. Provide the patient's full name, date of birth, age, and PEHP ID number.
- Move to Section II to fill in the provider information. Include the date requested, service provider name, NPI number, tax ID number, contact person's name, and relevant contact details.
- In Section III, specify the type of anesthesia being requested. Select from general, intravenous sedation, local, or nitrous oxide. Fill out the anticipated date of service and include any requested CPT/HCPCS codes.
- Identify the place of service by checking the appropriate box, and provide the facility name, NPI number, tax ID number, address, and phone number.
- Document the primary medical diagnosis using the corresponding ICD-10 code, and repeat for secondary medical diagnosis, as well as primary and secondary treatment diagnoses.
- Respond to the questions regarding the patient's condition by selecting 'Yes' or 'No' for each of the provided queries. This helps assess the necessity for anesthesia.
- If applicable, provide additional comments to clarify any specifics about the patient's conditions or needs.
- After you have completed all sections, review the form for accuracy. Save your changes, then you can choose to download, print, or share the completed form as necessary.
Complete your documents online today to ensure timely authorization for dental services.
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The CPT code for anesthesia services falls within the range of 00100 to 01999, which comprises various codes tailored for specific types of anesthesia used in dental and surgical procedures. These codes are critical for accurate billing and insurance claims. For anyone seeking to understand their coverage better, PEHP Health & Benefits Prior Authorization for Anesthesia Services For Dental Procedures Under provides essential clarity.
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