Get Geha Therapy Fax Request Form

The Geha Therapy Fax Request Form is essential for acquiring prior authorization of therapy services for GEHA members. This guide provides a clear, step-by-step approach to completing the form online to ensure a smooth submission process.

Follow the steps to successfully complete the Geha Therapy Fax Request Form online.

1. Press the ‘Get Form’ button to access the Geha Therapy Fax Request Form and open it in your preferred editor.
2. Provide the fax date and the total number of pages you are faxing. Direct the completed form to OrthoNet at the designated fax number (877) 304-4398.
3. Fill in the therapy provider information section, including the facility name, full address, telephone number, fax number, GEHA provider ID number, and national provider identifier (NPI) as applicable.
4. Complete the request information section, indicating the facility and individual tax ID numbers as required.
5. In the patient information section, fill out the patient’s first and last name, date of birth, and GEHA member ID number.
6. Indicate the request type for therapy services by selecting the appropriate option: onset of therapy services, extension of therapy services, or other procedures.
7. If applicable, specify whether this request pertains to post-operative therapy visits by selecting ‘Yes’ or ‘No.’
8. Select the type of service required (physical therapy, occupational therapy, or speech therapy) and fill in the initial evaluation date.
9. Ensure that all fields are filled in clearly, using black ink or a standard text format, and that any circles for options are completely filled.
10. Review the entire form for accuracy and completeness before proceeding to submit it.
11. Once you have filled out the form and made necessary changes, you can save your progress, download a copy for your records, print it, or share it as needed.

Complete the Geha Therapy Fax Request Form online today for efficient processing of your therapy service requests.