Get Sleep Study Prior Authorization Form - Neighborhood Health Plan Of ...

Navigating the prior authorization process for sleep studies can seem challenging, but with clear guidance, it becomes straightforward. This guide will help you fill out the Sleep Study Prior Authorization Form accurately and efficiently online.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Sleep Study Prior Authorization Form and open it in your preferred online document editor.
2. Begin by entering the member's information. Fill in the member’s name, member ID number, and date of birth in the designated fields.
3. Next, provide the provider’s name along with the provider's NPI number in the appropriate sections.
4. Indicate the date the request is being sent, the anticipated date of service, and any previous authorization number if applicable.
5. Fill in the place of service, specifying the city or town and facility. Include the provider’s contact information and fax number.
6. Enter the name of the ordering physician in the designated area.
7. Move to the clinical information section. Select or input the diagnosis and corresponding diagnosis code.
8. Provide the reason for the initial test in a facility and fill in the patient’s height, weight, and BMI as required.
9. Select the relevant checkboxes under the clinical information to specify the test requested, including options for polysomnography or other sleep studies.
10. If applicable, complete the section specifying the reason for any repeat testing.
11. The form must be signed by the treating physician. Ensure that the physician signs and dates the form.
12. After reviewing all entries for accuracy, save any changes made to the document. You can then choose to download, print, or share the completed form as needed.

Complete your documents online for a smoother authorization process.