Get Centene Enterprise Authorization Fax Form - Magnolia Health Plan

Filling out the Centene Enterprise Authorization Fax Form - Magnolia Health Plan accurately is essential for ensuring timely processing of your authorization requests. This guide provides clear, step-by-step instructions for completing the form online, ensuring that all necessary information is captured correctly.

Follow the steps to complete the authorization fax form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date of birth of the member in the designated field.
3. Fill in the member's ID or Medicaid ID in the required section.
4. Enter the requesting provider's NPI and TIN in the required fields.
5. Provide the requesting provider's contact name and phone number for follow-up.
6. For the servicing provider/facility information, fill out the servicing NPI and TIN.
7. If the servicing provider is the same as the requesting provider, select the appropriate checkbox.
8. Input the servicing provider's contact name and phone number.
9. Complete the authorization request section by entering the ICD-9 and ICD-10 codes as necessary.
10. Fill out the primary procedure code and any additional procedure codes, along with their respective modifiers.
11. Indicate the start date or admission date and the total units, visits, or days being requested.
12. If applicable, answer the questions regarding therapy services and the Individualized Education Program (IEP).
13. Select the outpatient service type by entering the corresponding service type number.
14. Ensure that all required fields marked with an asterisk have been filled out completely.
15. Once all sections are completed, you can choose to save changes, download, print, or share the form as needed.

Ensure your authorization requests are processed promptly by completing the Centene Enterprise Authorization Fax Form online.