Get Get Form - Avesis

Filling out the Get Form - Avesis is essential for obtaining authorization for necessary medical services. This guide provides clear instructions to help you navigate each section of the form seamlessly.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the member section. Input the member's plan ID, today's date, last name, first name, phone number, and date of birth.
3. Proceed to the provider section. Enter the provider ID, office contact, last name, first name, phone number, and fax number.
4. Fill out the facility details. Specify the type of facility (e.g., office, outpatient hospital, free-standing facility), facility name, address, city and state, phone number, and fax number.
5. In the procedure section, if available, indicate the planned date of service. Enter the primary ICD-9 code(s) and provide a description of the planned procedure.
6. Include details for old patient prescriptions for both the right and left eyes, followed by the new patient prescriptions for the right and left eyes, as well as the CPT/HCPCS codes and units.
7. Attach a pertinent clinical summary, ensuring that supporting clinical records are included.
8. After reviewing the form for any missing information, you may save changes, download, print, or share the form based on your needs.

Complete your Avesis forms online today to ensure timely processing of your authorization requests.