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Get Selecthealth Viscosupplementation Preauthorization Form - Zimmer
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How to fill out the SelectHealth Viscosupplementation Preauthorization Form - Zimmer online
Filling out the SelectHealth Viscosupplementation Preauthorization Form - Zimmer online can be straightforward when you have a clear understanding of each section. This guide provides detailed instructions to help you successfully complete the form.
Follow the steps to complete the form accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the patient's name in the designated field, followed by their ID number and date of birth. Make sure to provide a current phone number for the patient.
- In the diagnosis code section, input the relevant ICD-9 codes, ensuring accuracy for proper authorization. You may need to consult with a healthcare professional to obtain the correct codes.
- Fill out the requesting provider information, including name, phone number, address, and fax number. If applicable, ensure you include the supervising physician’s name.
- Answer the initial questions by selecting ‘Yes’ or ‘No’ as appropriate. Make sure you provide the required details, such as the consulting orthopedist’s name and the date of consultation if the prescribing physician is not a specialist.
- For the patient's osteoarthritis diagnosis, indicate whether it has been confirmed by radiographic evidence. Be aware of the patient's functional status to answer correctly regarding anticipated knee replacement and severity of impairment.
- Review the previous conservative treatments the patient has undergone and check off each one that they have failed. Ensure accuracy to prevent delays in the process.
- Finally, confirm the patient's age, ensuring they fall within the specified range, and provide insight into any previous failures with preferred viscosupplements.
- Once all sections are completed, save the changes. You may then download, print, or share the completed form as required.
Complete your documentation online to ensure prompt preauthorization.
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