Get Kaiser Permanente Colorado Prior Authorization Request Form - Info Kaiserpermanente
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Kaiser Permanente Colorado Prior Authorization Request Form - Info Kaiserpermanente online
Filling out the Kaiser Permanente Colorado Prior Authorization Request Form can seem daunting, but this guide will simplify the process for you. By following these step-by-step instructions, you will know exactly how to complete the form accurately and efficiently.
Follow the steps to successfully complete the Prior Authorization Request Form.
- Press the ‘Get Form’ button to obtain the form and access it in the designated editing space.
- Begin filling out the patient’s information. Enter the patient's Kaiser Permanente number, phone number, date of birth, last name, first name, address, city, state, and zip code in the corresponding fields.
- Provide the primary care provider (PCP) information including their name and phone number.
- Identify the referring physician by entering their name, specialty, and both phone and fax numbers.
- Complete the 'Preliminary Diagnosis' and include relevant ICD codes for the patient’s diagnosis.
- For the requested service, fill in the physician's name, specialty, and contact information. Specify the place of service and include applicable CPT or HCPC codes, quantities, procedures, and the description for each procedure.
- If the request is for services outside of the service area, provide a detailed indication for this request in the required section.
- Fill in the expected date of service and ensure all required information is provided as asked.
- Once all sections are completed, review the form for accuracy, save your changes, and proceed to download, print, or share the completed form.
Complete your Kaiser Permanente Colorado Prior Authorization Request Form online today!
Kaiser Permanente is the state's largest nonprofit health care provider, proudly working to improve the lives and health of Colorado residents for more than 50 years.
Fill Kaiser Permanente Colorado Prior Authorization Request Form - Info Kaiserpermanente
Fax the completed form to: . If the patient is not able to meet the above standard prior authorization requirements, please call 1-. COLORADO PRIOR AUTHORIZATION (PRE-CERTIFICATION) REQUEST FORM. Call the regional phone number if you have questions. Submit a medical request online, or find information about how to request medical care from Kaiser Permanente.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.