Get General Auth Request Form - Neighborhood Health Plan Of Rhode ...

Filling out the General Auth Request Form for Neighborhood Health Plan of Rhode Island can be straightforward if approached step by step. This guide will provide you with clear and supportive instructions to help you complete the form accurately online.

Follow the steps to successfully complete the General Auth Request Form

1. Press the ‘Get Form’ button to access the General Auth Request Form and open it in your preferred editor.
2. In the member information section, fill in the member's name, member ID number, and date of birth. Ensure that this information is accurate to avoid processing delays.
3. Next, provide the provider information. This includes entering the Supplier ID or National Provider Identifier (NPI) number, provider's name, date of request, date of service, previous authorization number, place of service, provider's phone and fax numbers, and the contact name.
4. In the clinical information section, fill in the CPT codes, number of units required, diagnosis details, and any additional procedure information that's necessary for the request. Be thorough, as this helps the review process.
5. Indicate the purpose of the referral clearly. This will assist in the evaluation of the authorization request.
6. A physician must sign the form. Ensure that the treating physician provides their signature and the date of signing, as this is a mandatory requirement.
7. Finally, review all entered information for accuracy before finalizing the document. Once satisfied, save the changes, and you will have the option to download, print, or share the completed form as required.

Start completing your General Auth Request Form online today.