Get Ca Blue Shield Treatment Authorization Request Form 2018-2026

Filling out the CA Blue Shield Treatment Authorization Request Form is a crucial step for accessing community-based adult services. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form online.

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Provide the member's name in the designated field at the top of the form. Ensure the name matches official documentation.
3. Enter the member's date of birth (DOB) in the format requested. This information is essential for verification purposes.
4. Fill in the member ID number. This unique identifier helps Blue Shield manage the member's account.
5. Input the member's phone number. This allows facilitators to contact the member if needed.
6. Indicate the CBAS facility name where services will be provided. This ensures the request is linked to the correct care setting.
7. Provide the facility's ID or NPI number. This information helps with service tracking and management.
8. Complete the CBAS facility address. Accurate address information is critical for service authorization.
9. Optionally, list the facility contact person's name for direct communication regarding the request.
10. Enter the facility's phone number for follow-up queries related to the request.
11. Add the facility's fax number if available, as this may be necessary for document sharing.
12. Attach updated Individualized Plan of Care (IPC) and participant attendance records for existing authorizations before submitting the request.
13. Provide a signature in the designated section, ensuring it is legible, followed by the printed name of the requesting provider.
14. Date the request to indicate when it was completed. This helps with processing timelines.
15. Review the information for accuracy before you finalize the submission.
16. Once completed, save changes to the form. You can then download, print, or share it as needed.

Complete the CA Blue Shield Treatment Authorization Request Form online today for timely service access.