Get Unmc Preauthorization Information Form 2018
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How to fill out the UNMC Preauthorization Information Form online
This guide provides clear, step-by-step instructions for filling out the UNMC Preauthorization Information Form online. The form is essential for obtaining insurance authorization for genetic testing prior to specimen collection.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to access the form and open it in your preferred editor.
- In the Patient Information section, enter the patient's name, medical record number, biological sex, phone number, address, city, state, and ZIP code.
- In the Insurance Information section, include a legible copy of both sides of the patient’s insurance card. If the policyholder is different from the patient, provide the policyholder's name and date of birth.
- In the Clinical Information section, attach relevant clinical records, such as family history, pedigree, and previous genetic testing reports. If the clinical records are provided through an electronic health record (EPIC), indicate the clinic date.
- Select the specimen type to be drawn by checking the appropriate box such as amniotic fluid, blood, or extracted DNA.
- In the Testing to Be Authorized section, indicate the tests requested and include the date of request and patient’s date of birth. Remember, this is not an order for testing.
- In the Provider Information section, fill in the provider's name, facility, address, city, state, ZIP code, and phone number. Specify any gene or mutation if applicable.
- Finally, review all entries for accuracy. Once confirmed, submit the form via email to clientservhgl@unmc.edu or fax to 402-559-7248.
Complete the UNMC Preauthorization Information Form online to facilitate insurance authorization for genetic testing.
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UNMC (University of Nebraska Medical Center) is an academic institution focused on education and research, while Nebraska Medicine serves as the clinical provider offering patient care services. Both establish a strong connection for healthcare advancements and medical training. If you need to navigate services between the two, having the UNMC Preauthorization Information Form can help clarify what is needed for specific requests.
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