Get Or Careoregon Inpatient - Prior Authorization Form 2017

Filling out the OR CareOregon Inpatient - Prior Authorization Form online can be a straightforward process when you have a clear guide. This document serves to help you understand each component of the form and provides step-by-step instructions for completing it accurately.

Follow the steps to fill out the form online effectively

1. Click ‘Get Form’ button to obtain the authorization form and open it in the editing interface.
2. Begin with the section labeled 'Person completing the form'. Enter the date, your name, and the name of the office where you work. Include your telephone number and fax number for contact purposes.
3. In the 'Member Name' section, fill in the last name, first name, date of birth, and subscriber ID of the individual needing authorization. Make sure to include the middle initial if applicable.
4. Complete the 'Provider Names' area by providing the names and fax numbers of the specialists involved, along with their respective clinic and facility names. Don't forget to include the tax identification number of the facility.
5. In the 'Diagnosis / Procedure Information' section, provide the primary diagnosis and procedure information. This should include the diagnostic code and the relevant CPT/CDT-4 codes for procedures. If there are secondary or additional procedures, include those as well.
6. Next, specify any comorbid conditions the member has. Indicate if they have a condition that is poorly controlled yet manageable. If applicable, provide the diagnostic code and a narrative description. Remember to attach relevant chart notes with your request.
7. Finally, indicate the level of care requested. For inpatient care, enter the anticipated or actual admission date and the anticipated number of days for the hospitalization.
8. After completing all the required fields, review the form for accuracy. Save your changes. You may also choose to download, print, or share the completed form as per your needs.

Start filling out your authorization form online today to ensure a smooth and efficient process.