Get Preauthorization Cahaba Form

Filling out the Preauthorization Cahaba Form online can seem daunting, but with clear guidance, it becomes manageable. This guide is designed to help users navigate through each section of the form efficiently and accurately.

Follow the steps to complete the Preauthorization Cahaba Form online.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. In Part A, begin by entering the 'Date of Request'. Indicate whether this is the first or second request by selecting the appropriate option.
3. Next, fill in the 'Beneficiary Information' section with the last name, first name, middle initial, address, health insurance claim number (HICN), date of birth (DOB), city, state, and zip code of the beneficiary. Also, provide the beneficiary's phone number.
4. Proceed to the 'Provider Information' section. Input the names and addresses for the performing provider and certifying provider, along with their respective provider numbers and contact details.
5. In the 'Start of Care' section, specify the treatment(s) requested, including the type of therapy (e.g., PT, SLP, OT) along with the number of visits already completed. Note the expected date range of services as well.
6. Indicate the number of additional treatment days requested and provide the date range from start to end.
7. Fill in the 'Diagnosis / Condition / Treatment Diagnosis' section by entering the relevant diagnosis codes. Ensure you complete all required fields.
8. Review the checklist of documents to be submitted with the form, including orders for therapy services, plan of treatment, evaluations, and progress reports.
9. Once all sections are filled out, save your changes, and prepare to download or print the completed form.
10. Finally, choose to fax the completed form to 1-855-629-7321 or mail it to the designated address provided in the instructions.

Begin completing your Preauthorization Cahaba Form online today to ensure prompt processing.