Get Optima-restore-pre-auth-form - Health Insurance

Filling out the Optima-Restore-Pre-Auth-Form - Health Insurance online is an important step in securing cashless hospitalization for medical treatment. This guide provides detailed instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the details of the Third Party Administrator (TPA) at the top of the form. Use block letters to provide the name of the TPA or insurance company, along with the toll-free phone number and fax number.
3. Proceed to the section labeled 'To be filled by insured/patient.' Enter the patient's name, select their gender, and provide the contact number. Make sure to also include the policy number or corporate name and indicate whether the patient currently has any health insurance.
4. Complete the patient's age and date of birth, ensuring the format is correct. Also, provide the insured member ID card number and employee ID, if applicable. Include the company name as well.
5. Indicate whether the patient has a family physician. If yes, provide the physician's name and contact number.
6. Next, move to the section that requires information from the treating doctor or hospital. Fill in the doctor’s name, contact number, nature of the illness, relevant clinical findings, and duration of the ailment.
7. Record past medical history and details regarding the proposed line of treatment. Include any relevant ICD codes and specify if the treatment involves surgery or medical management.
8. Document the expected duration of hospitalization and any costs associated with the stay, including room rent, nursing charges, and other hospital expenses.
9. Complete the declaration section by providing the treating doctor's name, qualification, and registration number. Ensure that the hospital seal is included.
10. The patient or their representative must sign the declaration, confirming their agreement to the terms outlined. Additionally, complete the hospital declaration ensuring all information is accurate and has been signed.
11. Attach necessary documents, as listed, to support the claim, and review all entries for accuracy before submission.
12. Finally, save your changes and choose the option to download, print, or share the completed form as needed.

Complete your documents online today to ensure a smooth pre-authorization process.