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  • Patient Payments Credit Card Pre-authorization Form - Availity

Get Patient Payments Credit Card Pre-authorization Form - Availity

CREDIT CARD PRE-AUTHORIZATION FORM I authorize to keep my signature on (Insert Name of Provider/Practice) file and to charge the credit card selected below for the following: ? Balance remaining after.

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Log in to Availity. Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations* Select Payer BCBSOK, then choose your organization. Select a Request Type and start request.

From the Availity home page, select Patient Registration from the top navigation. Select Auth/Referral Inquiry or Authorizations.

For questions about access and registration, call Availity Client Services at 800-Availity (800-282-4548).

How to access and use Availity Authorizations: Log in to Availity. Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations* Select Payer BCBSOK, then choose your organization. Select a Request Type and start request. Review and submit your request.

Get answers to your questions about eligibility, benefits, authorizations, claims status, and more: 1. Log in to Availity and select Anthem from the Payer Spaces drop-down menu. 2. From the Payer Spaces applications tab, select Chat with Payer.

Availity simplifies provider transactions such as electronic data exchange, prior authorization requests, claim status, and member inquiries.

From the Availity home page, select Patient Registration from the top navigation. Select Auth/Referral Inquiry or Authorizations.

282.4548 Monday–Friday, 8:00am to 8:00pm ET. Our Client Services team supports all Availity products and works with callers until an issue is resolved. For additional assistance, providers can call Availity Client Services @ 1.800. 282.4548 Monday–Friday, 8:00am to 8:00pm ET.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232