Get Centene Enterprise Authorization Fax Form

Filling out the Centene Enterprise Authorization Fax Form online can streamline the request process for additional units and clarify member information accurately. This guide provides clear, step-by-step instructions to assist users in completing the form seamlessly.

Follow the steps to complete the Centene Enterprise Authorization Fax Form online.

1. Click ‘Get Form’ button to obtain the Centene Enterprise Authorization Fax Form and open it for editing.
2. Begin by entering the member information, including the Member ID/Medicaid ID and the member’s date of birth in the respective fields.
3. Proceed to the requesting provider information section. Fill in the requesting NPI and TIN, along with the requesting provider contact name, phone number, and fax number.
4. If the servicing provider or facility information is the same as the requesting provider, check the corresponding box. Otherwise, provide the servicing NPI and TIN along with the contact name, provider or facility name.
5. In the authorization request section, specify the diagnosis codes, primary procedure codes, additional procedure codes, and the total units, visits, or days requested.
6. Enter the start date or admission date and end date or discharge date in the specified format.
7. Finally, indicate the outpatient service type by entering the appropriate service type number in the designated boxes.
8. Review the form for completeness. Ensure all required fields are filled in, as incomplete forms may be rejected.
9. Gather and attach any supporting clinical information required for the authorization request.
10. Once completed, save your changes, download the form, and consider printing or sharing it as needed.

Complete your Centene Enterprise Authorization Fax Form online today for a streamlined submission process.