Get Preauth Form - Capital Blue Cross

Filling out the Preauth Form for Capital Blue Cross is an important step in ensuring you receive the necessary therapy. This guide provides clear, step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to complete the Preauth Form smoothly.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. In Section I, enter the initial start date of therapy and the anticipated date of the next infusion. Ensure these dates are accurate to avoid processing delays.
3. In Section II, provide the member information, including the member's name, plan type, member ID, and date of birth. Make sure to double-check these details for correctness.
4. In Section III, complete the provider information. Input the requesting provider's name, address, CBC number, NPI number, telephone number, office contact name, specialty, place of service, fax number, and office contact telephone number.
5. In Section IV, specify the diagnosis by selecting the appropriate condition and entering the corresponding ICD code. If requesting initial authorization, confirm the first-line treatment and document the history of treatment failures.
6. For re-authorization, indicate whether the patient has demonstrated improvement and provide any necessary dosing information, including frequency and dosage.
7. In Section V, ensure the required physician signature is completed along with the date to validate the request.
8. After filling out all sections of the form, review your entries for accuracy and completeness, then save your changes. You can choose to download, print, or share the form as needed.

Complete your Preauth Form online today to ensure your therapy requests are processed efficiently.