Get Paramountpriorauthformimaging

Filling out the Paramountpriorauthformimaging is a crucial step for obtaining prior authorization for imaging services. This guide offers a clear, step-by-step approach to help users navigate the form effectively.

Follow the steps to complete the Paramountpriorauthformimaging online

1. Press the ‘Get Form’ button to access the Paramountpriorauthformimaging and open it for completion.
2. Enter the date of request in the designated field.
3. Fill in the date of the procedure in the corresponding section.
4. Provide the member's name and date of birth.
5. Input the Paramount member ID number.
6. List the name of the ordering physician and their provider ID.
7. Enter the contact person's name along with their phone and fax numbers.
8. Specify the facility where the procedure will be performed.
9. In the section for the body part to be tested, write the relevant information.
10. Select the test to be performed by checking the appropriate box, and fill in the CPT code for the selected test.
11. Indicate the diagnosis and enter the corresponding ICD-9 code.
12. Provide current signs and symptoms in the medical/clinical history section.
13. Document results of any relevant diagnostic testing.
14. Include any consultation or treatment documents that support the need for the procedure.
15. Once completed, save the changes to the form, and you can choose to download, print, or share the form as needed.

Take action now and complete your Paramountpriorauthformimaging online.