Get Siho Prior Authorization Form

Filling out the Siho Prior Authorization Form online can streamline your authorization requests and ensure that all necessary information is provided. This guide offers a step-by-step approach to help you complete the form accurately and efficiently.

Follow the steps to complete the Siho Prior Authorization Form online.

1. Click ‘Get Form’ button to obtain the Siho Prior Authorization Form and open it in your preferred online editor.
2. Enter the patient's name in the designated field at the top of the form. Make sure to spell the name correctly, as it is essential for accurate processing.
3. Fill in the requesting physician's name in the corresponding field. This should be the name of the healthcare provider making the authorization request.
4. Provide the patient's date of birth in the format: month, day, and year. This information helps to verify the patient's identity.
5. Enter the NPI or TIN number in the specified field. This identification number is crucial for billing purposes.
6. Input the patient's ID number provided by their insurance in the appropriate field.
7. Fill in the patient's address, ensuring all details are accurate and clear.
8. Document the diagnosis in the relevant section. Be as specific as possible to facilitate the authorization process.
9. Provide a phone number where the requesting physician can be reached for follow-up.
10. Specify the date of service in the appropriate format (month, day, year). This is critical for scheduling and processing the request.
11. Input the fax number for sending the authorization request once completed.
12. For the vendor or facility name, ensure to print the name accurately, followed by their NPI/TIN number and complete address.
13. Choose whether the equipment requested is for rental or purchase by checking the appropriate box.
14. Indicate the duration of use for the requested equipment.
15. Describe the type of equipment or HCPC codes required.
16. If applicable, attach additional documentation such as 02 sats, compliance reports, sleep study results, or improvement statements as necessary.
17. In the medications section, write the name of the drug requested and indicate any alternative drugs that have been tried and failed, if relevant.
18. If the physician will supply and bill for the medication, check the appropriate box and remember to attach the necessary MD orders and clinical information.
19. For outpatient services needed, check the relevant boxes and ensure to attach any required evaluation and treatment plans or scripts.
20. In the procedure codes section, list any relevant codes for inpatient surgery or other requested services.
21. Add any additional comments or details necessary to support the authorization request in the designated area.
22. Before finalizing, review all entered information for accuracy and completeness. Make any necessary changes.
23. Once finished, save your changes, download a copy, print the document, or share it as needed.

Complete the Siho Prior Authorization Form online today for a smoother authorization process.