Get New Prior Authorization Fax Forms - Sunshine State Health

Filling out the New Prior Authorization Fax Forms for Sunshine State Health can be a straightforward process when guided correctly. This comprehensive guide aims to assist you in understanding each component of the form and ensuring that all necessary information is provided accurately.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the New Prior Authorization Fax Form and open it in your preferred editing tool.
2. Begin by reviewing the Inpatient section. Select whether this is a standard request or an urgent request by checking the appropriate box. Remember that urgent requests require a physician's signature to be processed promptly.
3. Enter the Requesting Provider Information accurately. This includes the name, telephone number, fax number, and date of request. Ensure that all fields marked with an asterisk (*) are filled as they are required.
4. Fill in the Patient Information, including the patient's name, date of birth, and Medicaid ID number. These details are crucial for identifying the patient in the system.
5. Provide information regarding the requesting provider’s specialty and any other insurance details if applicable. This may require indicating whether the provider is participating or non-participating.
6. Detail the service or procedure requested, along with the corresponding CPT codes and ICD-9 codes. Make sure the requested dates of service are correctly documented.
7. Complete the servicing provider or facility information, filling in all required fields, including the servicing provider’s TIN and contact information.
8. Once all fields are completed, save the form as a new document. You can then print the completed form for submission.
9. Finally, fax the completed form along with any required supporting clinical information to 1-866-796-0526. Ensure all necessary documentation is included to avoid delays.

Start completing your forms online to ensure seamless processing and timely authorization.