Get Customer Advocate Unit Preauthorization Form - Bluecross ...

Completing the Customer Advocate Unit Preauthorization Form is a vital step in ensuring that necessary medical procedures are approved. This guide provides detailed, step-by-step instructions to help you accurately fill out the form online.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in an editor.
2. Begin by filling in the member's name in the designated field. This should reflect the full legal name of the individual seeking preauthorization.
3. Next, provide the complete address, including street, city, state, and zip code of the member to ensure accurate identification.
4. Enter the member's phone number in the appropriate section to facilitate communication regarding the request.
5. Fill in the member ID number, which can be found on the member's insurance card.
6. Specify the member's date of birth, ensuring to include the three-letter prefix as required.
7. Indicate the diagnosis by entering the corresponding ICD9 code(s) in the provided space.
8. Input the CPT code(s) along with a brief description of the services being requested.
9. Provide the date of service for which preauthorization is being requested.
10. Select whether the service is for outpatient, MD office, or inpatient by circling your choice.
11. Enter the facility name and address where the services will be provided.
12. Fill in the name of the medical doctor (MD) associated with the request, followed by their address.
13. Provide the fax number and phone number for the medical doctor to ensure prompt communication.
14. Enter the provider ID and NPI numbers as applicable for the medical provider.
15. Complete the office contact information and their extension for any follow-up queries.
16. Make sure to include any necessary documentation to support medical necessity alongside the form.
17. Review the entire form for accuracy before submitting it. Once completed, users can save changes, download, print, or share the form.

Complete your documents online now to ensure timely processing.