Get Centene Enterprise Authorization Fax Form - Coordinated Care Health

Filling out the Centene Enterprise Authorization Fax Form - Coordinated Care Health is an essential step in ensuring that users receive the necessary medical services promptly. This guide provides clear instructions on how to complete the form accurately and effectively to facilitate the authorization process.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the Centene Enterprise Authorization Fax Form - Coordinated Care Health and open it in your preferred digital editing tool.
2. Fill in the member information section by providing the member ID or Medicaid ID, member's last name, first name, and date of birth in the required format (MMDDYYYY). Make sure all fields are accurately completed.
3. In the requesting provider information section, enter the requesting provider's National Provider Identifier (NPI) and Tax Identification Number (TIN). Also, include the contact name, provider name, phone number, and fax number for clear communication.
4. If applicable, check the box indicating whether the request is urgent. If it is urgent, ensure that the requesting physician signs the form to highlight the medical necessity of a timely decision.
5. Complete the servicing provider/facility information if it differs from the requesting provider. Include the servicing provider's NPI, TIN, name, contact name, phone number, and fax number.
6. In the authorization request section, provide the primary procedure code, start date or admission date, diagnosis code, additional procedure code, end date or discharge date, and total units/visits/days as required.
7. Select the outpatient service type by filling in the square with an X next to the relevant category that applies to the authorization request.
8. Review the entire form to ensure that all required fields are filled in. Incomplete forms will be rejected, so double-check your entries.
9. Attach any supporting clinical information as specified. Lacking this information may cause delays in the determination process.
10. Once you have verified that all information is complete, save your changes, and download or print the form as needed for submission.

Complete your Centene Enterprise Authorization Fax Form - Coordinated Care Health online today!