Get Centene Enterprise Authorization Fax Form. Universal Fax Authorization Form

The Centene Enterprise Authorization Fax Form is a crucial document for requesting prior authorizations and referrals in healthcare settings. This guide will provide you with comprehensive, step-by-step instructions to assist you in accurately completing the form online.

Follow the steps to effectively complete the authorization fax form

1. Press the ‘Get Form’ button to access the authorization fax form and open it in your editing interface.
2. Begin by entering the member information. Fill in the required fields such as the member ID or Medicaid ID, date of birth, last name, and first name. Ensure that the member phone number is accurately recorded.
3. Proceed to the requesting provider information. Enter the requesting NPI (National Provider Identifier) and TIN (Tax Identification Number). Include the name of the requesting provider and the contact person, followed by their phone and fax numbers.
4. If applicable, fill in the servicing provider or facility information. Indicate whether it is the same as the requesting provider or input new NPI and TIN. Provide the servicing provider’s name and contact details.
5. In the authorization request section, fill out the necessary procedure codes including ICD-9 and ICD-10 codes, primary procedure code, start or admission date, and total units or visits required.
6. Select the outpatient service type by entering the corresponding service type number. Choose from the list provided such as biopharmacy, imaging services, or outpatient hospice.
7. Include any additional procedure codes if applicable and specify the end date or discharge date.
8. Review the completed form for accuracy. Ensure that all required fields are filled in, as incomplete forms will be rejected. Attach all supporting clinical documentation, as lack of information may lead to delayed determinations.
9. Once the form is completed, you can save the changes you made, download the document, print it, or share it as needed.

Complete your authorization documents online with confidence and ensure timely processing.