Get Bcbs Of Alabama Precertification Forms

Filling out the Bcbs Of Alabama Precertification Forms accurately is crucial for obtaining prior authorization for physical therapy services. This guide provides you with step-by-step instructions to help you complete the form online seamlessly.

Follow the steps to fill out the Bcbs Of Alabama Precertification Forms online.

1. Click ‘Get Form’ button to access the precertification form and open it in your preferred editing tool.
2. Enter the contract number, including any required prefix. This number is usually found on the Blue Cross identification card.
3. Input the group number as it appears on the patient’s Blue Cross identification card.
4. Provide the subscriber's name in the format: last name, first name, and middle initial.
5. Fill in the patient’s name, beginning with the last name, followed by the first name and middle initial.
6. Record the patient’s date of birth, including the month, date, and year.
7. Enter the ordering provider's name using both first and last names.
8. Document the ordering provider's National Provider Identifier (NPI).
9. Provide the complete address for the ordering provider, including street, city, and state.
10. Fill in the therapist’s name, specifying the licensed physical therapist providing care.
11. Insert the therapist's NPI. If the therapist is affiliated with a hospital, record that hospital's NPI.
12. Enter the therapist's office phone number, including the area code.
13. Provide the fax number for the therapist's office, including the area code.
14. Document the therapist's facility name where treatments are conducted.
15. Fill in the facility address, including city and state, where physical therapy services will be performed.
16. Enter the therapist’s email address to facilitate communication.
17. List the primary diagnosis code relating to the patient and the onset date. Ensure no ‘V’ codes are used.
18. Record any secondary diagnosis codes pertinent to the patient’s treatment, also specifying the onset date.
19. Indicate whether the patient has undergone surgery by selecting Yes or No, and provide the date and type of surgery if applicable.
20. Check if the patient has sustained an injury during therapy and fill in the date and type of injury if applicable.
21. Specify whether the patient has previously received therapy for this condition, and include relevant dates.
22. Provide a list of any medical or surgical complications the patient has experienced along with the corresponding dates.
23. List all dates of service for the current calendar year, ensuring accurate entries for proper review.
24. Indicate if this is an initial certification request by checking the appropriate box.
25. If additional visits are being requested, check the box for additional certification.
26. If appealing a non-certification, check the corresponding box and include any additional clinical information to support the appeal.
27. Once all fields are completed, review your entries for accuracy. You may now save changes, download, print, or share the completed form as needed.

Start filling out your Bcbs Of Alabama Precertification Forms online today for efficient processing of your requests.