Get Outpatient Quality Review Form And Instructions - New Directions ...

Completing the Outpatient Quality Review Form is essential for facilitating the proper authorization and delivery of services. This guide provides comprehensive instructions on filling out the form accurately, ensuring all required information is provided for a smoother submission process.

Follow the steps to successfully complete the form online

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Fill in the provider information section using capital letters, including the provider’s name, NPI number, and office zip code. Indicate if any information has changed since the last request.
3. Complete the client information section by printing the client's name as it appears on the insurance card, their birth date in MM/DD/YYYY format, and the insurance ID number.
4. In the authorization information section, select only one service box. For therapy services, include the appropriate CPT codes, and do not write a group name or NPI.
5. Indicate whether this is the client's first visit and complete or leave the form as instructed. If it is not the first visit, proceed to fill out the entire form.
6. Enter the treatment request date in MM/DD/YYYY format, select the number of requested visits up to 8, and provide the estimated number of visits needed for treatment.
7. In the diagnostic information section, provide numeric diagnosis codes for Axis I and/or Axis II, and include the numeric Axis V (Global Assessment Functioning) score.
8. Complete the medications section by selecting the types of medications the client is taking and indicate the client’s adherence status.
9. Assess the current risk factors and select the appropriate severity rating for each relevant category, ensuring all items are filled out to avoid additional forms.
10. Finish with the treatment information section, answering yes, no, or not applicable to each question regarding care coordination and treatment progress.
11. Review all sections to ensure accuracy, save changes, download, print, or share the completed form as required.

Complete your Outpatient Quality Review Form online now for efficient processing.