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Pain Management Authorization (epidurals, facets, ablations, spinal stimulators, pain pumps) Date of request: Anticipated service date: Patient name: ID number: Date of birth: Provider name: Tax ID:.

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As used in this policy, terms such as "we" or "our" and "Company" refer to OrthoNet (an Optum company) and its current and future affiliated entities, including Optum parent company UnitedHealth Group.

GEHA (Government Employees Health Association) is a self-insured, not-for-profit association providing medical and dental plans to federal employees and retirees and their families through the Federal Employees Health Benefits (FEHB) program and the Federal Employees Dental and Vision Insurance Program (FEDVIP).

Refer to the back of the patient's ID card under the heading Prior Authorization for the appropriate contact information. You can use this form to initiate your precertification request. The form will also help you know what supporting documentation is needed for GEHA to review your request.

Prior authorization in health care is a requirement that a healthcare provider (such as your primary care physician or a hospital) gets approval from your insurance plan before prescribing you medication or doing a medical procedure.

For more than 86 years, GEHA (Government Employees Health Association) has provided medical plans designed exclusively for federal employees.

GEHA requires preauthorization to ensure evidence-based medicine supports the requested service. Preauthorization helps decrease avoidable complications and prevent unnecessary treatment, which can help reduce the premiums for our members.

Should you need to, you may call OrthoNet's Provider Service Department at 1-800-401-0062 to ascertain the status of a member's authorization request. Our authorizations all bear expiration dates.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232