Get Or Health Net Xo-paf-1649 2017-2025

The OR Health Net XO-PAF-1649 form is essential for several healthcare authorization requests in Oregon Healthnet. This guide provides clear directions on completing the form online to ensure a smooth submission process.

Follow the steps to successfully complete the OR Health Net XO-PAF-1649 online.

1. Click ‘Get Form’ button to obtain the form and access it for completion.
2. Fill in the member information section. You will need to provide the member ID, last name, first name, and date of birth in the specified format (MMDDYYYY).
3. Complete the requesting provider information. Input the requesting NPI (National Provider Identifier) and TIN (Tax Identification Number) along with the requesting provider contact name, phone number, and fax number.
4. If applicable, indicate if the servicing provider is the same as the requesting provider by checking the respective box. Otherwise, provide the servicing provider’s NPI and TIN along with their contact name, phone, and fax information.
5. In the authorization request section, enter the primary procedure code as well as any additional procedure codes, diagnosis codes, and modifiers needed for the request, ensuring all required fields are completed.
6. Select the inpatient service type from the options provided and ensure the correct choice is made.
7. Double-check that all required fields are filled, as incomplete forms will be rejected. Attach all necessary supporting clinical information since a lack of documentation may cause delays.
8. Once the form is completed, you can save your changes, download a copy for your records, and proceed to print or share the form as necessary.

Complete your documents online for fast and efficient processing.