Get Outpatient Prior Authorization Form - Magnolia Health Plan

Filling out the Outpatient Prior Authorization Form for the Magnolia Health Plan can be a straightforward process with careful attention to detail. This guide will assist you in completing the form online, ensuring you provide all necessary information for a successful submission.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the member information section. Enter the member's date of birth, member ID or Medicaid ID, and ensure all required fields, marked with an asterisk (*), are completed.
3. Next, provide the requesting provider information, including the requesting NPI, TIN, contact name, provider name, and phone number. All these fields are essential for processing.
4. In the servicing provider/facility information section, if the servicing provider is the same as the requesting provider, check the box that states 'Same as requesting provider.' If not, fill in their NPI, TIN, contact name, and phone.
5. Proceed to the authorization request section. Enter the primary procedure code and additional procedure codes as necessary. You will also need to input the total units, visits, or days required.
6. For school-aged members with disabilities/special needs, respond to the questions regarding therapy services and individualized education programs (IEP). Ensure all relevant documentation is attached.
7. Select the appropriate outpatient service type by entering the corresponding service type number in the designated boxes. Examples are provided for reference.
8. Review the entire form for completeness and accuracy. Ensure all required fields are filled to avoid rejection due to incomplete information.
9. Once all sections are completed and reviewed, you can save changes, download, print, or share the final version of the filled form.

Start completing your Outpatient Prior Authorization Form online today to ensure timely processing.