Get Preauthorization / Physician Fax Form - Blue Cross Blue ...

Filling out the Preauthorization / Physician FAX Form for Blue Cross Blue can seem daunting, but this guide will assist you through the process. With clear, step-by-step instructions, you will be able to complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the form and open it in your editor.
2. Fill in today's date in the designated field at the top of the form. This ensures the documentation is current.
3. Provide the patient's information by entering the patient's first name, last name, middle initial, date of birth, and telephone number in the corresponding fields.
4. Complete the insurance information section with the patient's Blue Cross Blue Shield ID number and group number.
5. Next, enter the prescriber's details, including their name, UPIN number, clinic name, clinic address, city, state, zip code, NPI number, specialty, phone number, and the contact person's name and secure fax number.
6. In the preauthorization information section, provide the patient's diagnosis along with the appropriate ICD-9 code. Answer the questions regarding documented skin tests or current treatment with by selecting 'YES' or 'NO.'
7. If you are completing the initial request section, check all applicable boxes regarding the patient's medication history. Indicate any contraindications and provide explanations where necessary.
8. If you are completing the renewal request section, answer the questions about the patient's asthma symptoms, inhaled corticosteroid therapy, and any changes in weight that may require a dose adjustment.
9. Enter the patient's weight in kilograms, the date the weight was measured, the patient's pre-treatment IgE test result, and the date it was measured.
10. Specify the requested dose in milligrams and frequency of administration in the indicated fields.
11. Once all sections are completed, review all information for accuracy and completeness to prevent delays.
12. Save your changes, and you can download, print, or share the form as needed before sending it to the appropriate address provided on the form.

Complete your documents online today to ensure timely processing.